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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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />10.my <br /> Paper towels and pump-style soap container. <br />13,Names of responsible persons to be present in booth during all hours of operation: <br />"•Important** <br />14.Completed <br />ignature Date <br />Health Permit <br />Paper Hand Towels <br />| Cutting Board I <br />Propane Stove Bleach <br />Page 8 of 11 TEMP EVENT APP <br />EHD 16-02 <br />10/13/09 <br />5 Gai Hanc wash <br />Arastewater Container <br />5-20 Gal <br />Hand wash Waer <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br /> Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot) <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Sterno wOaffing <br />Dish <br />Sanitizer bucket <br />bleach & water for <br />storing wiping cloths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment sink. <br />Garbage <br />Can <br />Up <br />Title <br />-------------Ice Cooler <br />' Pr°vid]n9 the Allowing cold temperature control for the cold holding of potentially hazardous foods below <br />45 F (If food is used the following day, maintain below 41 °F temperature): <br />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 orinr to <br />this event. /\\ --------- <br />Ettra ice Bags & Food ConBiners mast be <br />stored 6 inches off of the ground' <br /> Ice chests Q Refrigerator <br /> Refrigerated truck ice bath and tubs <br />•0 Other (specify) <br />■ ?~^7 <br />| Soap and Water | F <br />Fire Extinguisher <br />Propane Tank <br />j Soap dispenser I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />Dootn: <br />2 JiX™* ,,r !“p, M w <br />Rinse Water ] j B each and Water <br />( Extra \ <br />Water
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