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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HARLAN
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11980
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1600 - Food Program
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PR0540824
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COMPLIANCE INFO
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Entry Properties
Last modified
7/5/2026 9:59:18 AM
Creation date
7/5/2026 9:57:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0540824
PE
1695 - TEMPORARY EVENT
FACILITY_ID
FA0023335
FACILITY_NAME
1ST ANNUAL GHIRARDELLI CHOCOLATE JUBILEE
STREET_NUMBER
11980
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\bmascaro
Supplemental fields
Site Address
11980 S HARLAN RD LATHROP 95330
Tags
EHD - Public
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Mar. 4. 201 6 1 2:59PM GHI RARDELL I No. 2854 P. 30 <br />Date(s): <br />2. <br />Phcna; <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />ineats, tamales, cooked beans, rice. <br />Page 7 cf 'll TEMP EVENT AP>P <br />4. 2016 12:50PM No. 0539 <br />EHD IG-Oz <br />11/^/14 <br />"es No <br />. „ ------------- „J include: <br />vecjetableSy potato salad, eggs, and dairy products. <br />Received Time Mar. <br />Q Camp stove Q sterno & hotel trays <br /> Double steamer steam table & lids <br />■- '□■Electric stove top Other (specify) <br />Note; Examples of potentially hazardous food <br />required to return a signed and completed copy of this checklist to <br />3/ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are ' <br />the festival coordinator three (3) weeks prior to this event, <br />1. 1, Name of Event: & j7Z j fig. Ltr C krX.t j - J m /j <br />The following is Information about my organization/buapeee: <br />Namo of organjzation/business: <br />Address: 12:ci /Vfrk-i'i lAJ-j ( <br /> ! /ft, A'terriate ^><y/z-3ggo <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: [UKtes Q No <br />All food is prepared qn-site orfefrom approved commercial facilities: <br />Name of facility: . J\)j Phone: f ) <br />Address of faeditv.- /Z I <br />1 adust and the public)1 f0|l0Wlr>9: Prolect mv unpackaged food and food-preparation areas from flies, <br />£meninoth™^!? cwst?JclJed ei(her wood' car>vas, plastic, similar material and fine mesh fly <br />NeTT V ®nc,os"jg °Pe" food «reas. It will also have a smooth and cleanable floor (concrete <br />Stm the public8 K W0°d 3CCsptabl^ and instructed to separate food and food preparation <br />□^er(Spgcify):^^^^^/^^0// <br />N°fe: Intovla HPerati°nS nOt reqUired t0 provlde enclosed booths ere those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. d <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />M Approved bottled wafer. <br /> On-site hose bib that is connected to a pofablo water source. <br /> <br />Electricity is provided for my booth's use: ^J.-Ves [j^o <br />' ,h’ “ “d “w h°'d'"s <br />1 a£££V,dln9 016 following 1x31 femparature control for the hot holding of all potentially hazardous foods above
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