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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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PEARSON
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11335
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1600 - Food Program
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PR0521340
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COMPLIANCE INFO
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Entry Properties
Last modified
6/28/2026 12:44:19 PM
Creation date
6/28/2026 12:42:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0521340
PE
1695 - TEMPORARY EVENT
FACILITY_ID
FA0012744
FACILITY_NAME
CAMBODIAN HOLIDAY
STREET_NUMBER
11335
STREET_NAME
PEARSON
STREET_TYPE
RD
City
LODI
Zip
95240
APN
05917014
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\bmascaro
Supplemental fields
Site Address
11335 PEARSON RD LODI 95240
Tags
EHD - Public
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Environmental Health Department <br />10. <br />• 12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />Completedby:14.TitleSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Bleach and Water <br />Fire Extinguisher <br />7 <br />Soap and Water <br />I am providing the <br />booth: <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Water <br />_a <br />Ice Cooler <br />SANJOAQUIN <br />—county---- <br />Greotness grows here <br />providing the following cold temperature control for the cold holding of potentially hazardous foods belowI am <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />O^ce chests Refrigerator <br />O Refrigerated truck ED Ice bath and tubs <br /> Other (specify)- <br />7~ <br />Rinse Water <br />11. I amproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />^7i37hree compartment sink. <br />OR <br />Propane Tank <br />’ 209 468-3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 of 11 TEMP EVENT APP1868 E. Hazelton Avenue | Stockton, California 95205 | T <br />EHD 16-02 <br />Extra Ice Bags & Food Containers must be M <br />stored 6 inches off of the ground1 H <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />-preparationTpr this event. A copy of this checklist must be in the booth at all hours of preparation/and operation. Return original to festival coordinator three weeks Pnor to <br /> <br />/ Dafte Z <br />j^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br />I<6)^^ t ------- <br />**lmportant** <br />f this event. <br />iration/and operation. <br />jvepf. , _____ <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />v/^^Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />following for adequate hand washing facilities, but separate from utensil wash within my <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot).
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