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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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D
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DE VRIES
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12145
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1600 - Food Program
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PR0526555
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COMPLIANCE INFO
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Entry Properties
Last modified
7/12/2026 10:56:27 AM
Creation date
7/12/2026 10:49:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0526555
PE
1695 - TEMPORARY EVENT
FACILITY_ID
FA0017972
FACILITY_NAME
KINGDON DRAGS
STREET_NUMBER
12145
Direction
N
STREET_NAME
DE VRIES
STREET_TYPE
RD
City
LODI
Zip
95242
APN
05518005
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\jcastaneda
Supplemental fields
Site Address
12145 N DE VRIES RD LODI 95242
Tags
EHD - Public
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KD2 (l).jpg <br /> <br />3/12/2018 <br />Date(s): <br />2. <br />Phone. <br />3. <br />4. <br />5. <br />6. <br />8. <br />meats, tamales, cooked beans, rice, <br />TEMPEVEWT APP <br />VtHKTTOayw! <br />135’F. <br /> Camp stove Stemo & hotel trays <br /> Double steamer Q Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentiaBy hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to a and «w <* ws Checklist to <br />1. Name of Event <br />The following is information about my organizatxxVbusiness:. . <br />Name of organizatfon/business: <br />Adrfoess: 4l01 Dr .5/^, <br /> AB^f ) <br />List food to be sold or given to the public. <br />I am providing food that is NOT prepared af home; Yes (JjNo <br />All food is prepared on-site or is from approved commercial facilities:® Yes No , <br />Name of facility: Phone: (?/C) 4 7 T^"^' <br />Address of facilltv: I (TiyT Ctf’ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screenmg completely enclosing open food areas. It will also have a smooth and deenable floor (concrete, <br />^ras from^ie p<S Srn0Olh W00d 3,16 BcceP,able> and constructed to separate food and food preparation <br />pother (specify): ^*V<4. V ________________ _____________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />Approved water for drinking utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />^Other(specify): 3 C****l ____ <br />Electricity is provided for my booth's use: ^Ufes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: $(Yes No <br />7 ' Providin9 tlle following hot temperature control for the hot holding of all potentially hazardous foods above
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