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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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8. <br />9 <br />OR <br />10. <br />13 <br />14.Completed <br />Sign;ire <br />I Health Permit f <br />PaprMantjTowdt| Sc« expense- [ <br />Cuftnj Bci.ts 3 E eacn <br />I <br />Rmsa t^zeer <br />Pajje iof «TEMP EVENT APP <br />EMO 16-02 <br />10/13<Cd <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />□ Ice bath and tubs <br />t> Ga. <br />'.'/ssleArator Ont ere.- <br />Garbage <br />Can <br />Sanonr budtnt- <br />«J000 4w»t*rfor <br />M0nr.q w^r-j c‘cr& <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, ora Tarp <br />5-20 <br />Harfrl Aft <br />"5 cu — <br />Title <br />Sitra tx Bays A Awtf Cer,Bt-afs mjs Ce <br />stsfea 6 reftss off t>t thagnung <br />.. . <br />■ I _ <br />Ice CooleTp <br />Stomp wChalit} |__ <br />rJTT <br />Sow em Mmr j J j B ftaen anc Waler j <br />Him,providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />[RViater supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br />fJOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />:ZTPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation'V/A)(e /X-tcp^tr^/zizv/r 7^/z.k.o^>^- <br />’•Important" All food vendor booths are subject to inspection. Please make a copy of this application In <br />preparation for this event A copy of this checklist must be in the booth at all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45 F (if food is used the following day. maintain below 41T temperature). /fl. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />^o^onl^bleX o?biea“aton?fUX)ne 006 '°r * <br />^Detergent, bleach, and wiping cloths (cleaning towels). <br />SEfTub to store wiping cloths in bleach solution.
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