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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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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TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6.Approvi <br />7. <br />8. <br />7. <br />meats, tamales, cooked beans, rice, <br />Page 7 ot 11 TEMP EVENT APP <br />• <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br /> Stemo & hotel trays <br />fE^Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Electricity is provided for my booth’s use: <br />EHD 16-02 <br />mioim <br /> YesB'So"' <br />^dX^me^ ’* C°ld 01 hazafdous <br />I am providing the following hot temperature control for the hot holding of all pctenbalfy hazardous foods above <br />135 F‘ <br />booth with walls and ceffing constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete. <br />areaTfronTm1 pu^ Srnoottl wood are accePtai)le) and constructed to separate food and food preparation <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />ter for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />B^pproved bottled water <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):________ <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator threa.(3) weeks prior to this event <br />Name of Event Date(s): /z> <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address- ^2—^ S •/- <br />Phone: (^g^) *4 ~7f Z. Attemate: ( ) <br />List food to be sold or given to the pubfic: <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: B'Yk No <br />Name of facility: K F 6 B d?Phone: <br />Address of facility.. <br />dust artothe p follow'ns: Protect '"V unpackaged food and food-preparation areas from flies.
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