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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.hazardous foods bdow <br />I am providing the fotowing terns vrtein my bocii for the sanaary desrsig of food preparstion utensils:9. <br />□ Three compartment sink. <br />□ Detergent, bleach, and wiping cloths (deaTng ciwets . <br />□ Tub to store wiping cloths in bleach sokjocr. <br />10. <br />13.NanTe^f^pon^tepersora aabe present mooofi arr<g M hours of opertecrz <br />"Important" <br />14. <br />Health Pennit <br />?Paeczt-'.iftiKrWi <br />Prepare <br />I Prepare Tsrx <br />] <br />Pas®8o?H TEU» EVENT AFP <br />T <br />EHD 16-02 <br />10/13/09 <br />Garbage <br />Can <br />$ aatrer tu>€t <br />i'-iach a oarrtcr <br />XinxiapraccrB <br />Booth must be on <br />Concrete. Aspha't, <br />Plywood, or a Tarp. <br />5C3 <br />VJmtusev Qor.-jtcuE1W teeBs^S 6 rvvl Cxa ‘KfZ cos be <br />i^ied 6 tKfcsj atzfz^xxr^ <br />.... <br />I Ice Cooler ! i <br />I V <br />rarn praviefing the following for adequate hand wasnrsc astces, pa secarae torn utensJ wash within my <br />U^Afater supply rfispenser with warm wasar at a rvnjr of 10TF fee. 5-2C gator, coraaner with ^Hgot). <br />□ One separate tub (bucket or basin; for re ccteracr. of rinsawastewaer. <br />All food vendor boots are siject c nspecscn. Ptease make a copy Of this appScatton in <br />preperation for ths evert A copy of tris checklist must be in the booth at afl hous of <br />prepaatfon and operaacn. Return original to fegttvai coordinator three weeks prior to <br />Bus event <br />-Xr. . Y. <br />/ Signature <br />OR <br />^^Three deep tuts (basins 6-8 inches rrtojrsurtj. one for soapy wstsc one far mssig and one for a bleach <br />'solution (one tablespoon of bleach per gator, of vray. <br />| OreiWr |-----1 <br />| I ExsncTiv&srSo^irav^r J| <br />I am prpvxing the fotetog cold temperature control for the cold hddsng of potentr <br />45T (if food is used^Mitowir^ day, mamtan below 41T temperature); <br />^25 ice chests O RefngeratDr <br />□ R^ngoraiec buck O Ice bath and tuas <br />(E^Xher (soedfv) ■TV'jL2-X-Cj<________________________________ <br />r\ J— I <br />>
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