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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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6 <br />h <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone. <br />3. <br />4. <br />5.(to protect my unpackaged food and food-preparation areas from flies, <br />6. <br />7. <br />135'F: <br />meats, tamales, cooked beans, rice, <br />Pagerorn TEMP EVENT ARP <br />/ <br />EHO 18-02 <br />ro'iM» <br /> Camp stove <br /> Double steamer <br /> Electric stove top CP <br />^fstemo & hotel trays <br /> Steam table & lids <br />r0-Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />EfTT booth with walls and ceiling 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 />asphalt, dean tarps and smooth wood are acceptac.e) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify):______________ <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):_______________________ ____________________ <br />7. Electricity is provided for my booth’s use: Yes^-No <br />8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially harantn.* <br />foods during all times of booth operation^jYes No <br />1^ am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />t <br />Name of organization/business. <br />Address: <br />) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event ’J3 J<-/ <br />lAlA----________________________Date(s): 9 , 9 - J- jCj <br />>ouppy organizatipn/business: <br />)Cld? VCXa 1\ <br />S' Alternate: ( ) Al// <br />List food to be sold or given to the puMcTTe) I < iTS^ OSfiYl/ <br />I am providing food that is NOT prepared at home: ^Yes No <br />All food is prepared on-site or is from approved commercial facilities^^Yes No <br />Name of facility: X / Z. Phone: ( ) <br />Address of facility: ' / <br />I am providing a booth with the followirig: (to pi------ ' ‘ ' <br />dust and the public) <br />All food vendors (both for profit and non-profit) <br />Name of Event: <br />The following is informalioo
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