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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MICKE GROVE
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11793
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1600 - Food Program
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PR0541038
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COMPLIANCE INFO
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Entry Properties
Last modified
6/5/2026 8:54:28 AM
Creation date
6/5/2026 8:53:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0541038
PE
1695 - TEMPORARY EVENT
FACILITY_ID
FA0023499
FACILITY_NAME
PACIFIC SERVICE EMPLOYEES ASSOCIATION
STREET_NUMBER
11793
Direction
N
STREET_NAME
MICKE GROVE
STREET_TYPE
RD
City
LODI
Zip
95240
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\tchampion
Supplemental fields
Site Address
11793 N MICKE GROVE RD LODI 95240
Tags
EHD - Public
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10. <br />kiI am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: /'^ <br />S Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />15.Completed by: <br />Health Permit p <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />fl/d <br />Bleach and Water <br />Fire ExtinguisherD <br />TEMP EVENT APRPage 8 of 11EHD 16-02 <br />7/14/15 <br />I^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />I am 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 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 prior to <br />this event. <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Soap and Water Rinse Water <br />Extra Ice Bags & Food Containers must be H <br />stored 6 inches off of the ground! iI <br />El Refrigerator <br />□ Ice bath and tubs <br />z/0 <br />w <br />Propane T ank ----------------> <br />JF/ <br />0 <br />‘‘Important** <br />/..................... <br />Ice Cooler <br />lOd J t—J <br />Names of responsible persons to be present in booth during all hours of operation: <br />____ <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />6 <br />Date“ Title Q <br />----------------- -----------S <br />Garbage <br />Can <br />□ Ice chests <br />□ Refrigerated truck <br />153 Other (specify)
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