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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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T
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12 (STATE ROUTE 12)
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9009
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1600 - Food Program
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PR0540196
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COMPLIANCE INFO
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Entry Properties
Last modified
6/12/2026 10:56:10 AM
Creation date
6/12/2026 10:54:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0540196
PE
1695 - TEMPORARY EVENT
FACILITY_ID
FA0022982
FACILITY_NAME
CAJUN AND BLUES FESTIVAL
STREET_NUMBER
9009
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95242
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\tchampion
Supplemental fields
Site Address
9009 W STATE ROUTE 12 LODI 95242
Tags
EHD - Public
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@00206/09/2016 17:36 FAX 8317245784 <br />10. <br />I am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />12. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth:13. <br />14. <br />••Important** <br />Completed by: 15. <br />^/'Signature <br />Health Permit <br />! <br />Paper Hand Tow»i» <br />Soap dispenser <br />CutUno e&ard <br />BlaachPropane Stova <br />Lb <br />Fira ExfcnaulBhar <br />Ice Cooler ; <br />TEMP EVENT APP <br /> <br />PAnft 8 of 11 <br /> <br />EHD 16-02 <br />L <br />Soap and Water Rins# Watar <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />□ Refrigerator <br />0 Ice bath and tubs <br />Sunltixer bucket <br />bleach & water for <br />Itorirtg wiping doth® <br />Booth must be or <br />Concrete, Asphalt <br />Plywood, ora Tar; <br />Q Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Starrto w?C hefting <br />Dl»h <br />Extra <br />Water <br />6 Gal Hand with <br />Waatewater Container <br />.4-20 Gal. <br />Hand waah Water <br />Own-e^ <br />Title <br />^74 <br />Date <br />PropaneTank <br />^7 <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 feyttval coordinator three weeks prior to <br />this event,-^7^7 7 <br />j^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 />Names of responsible persons to be present in4x)oth during all hours of operation: <br />A4a <C/rz<7/< ------------------------ <br />Garbage <br />Can <br />JTfWater 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-gtyle. aafi <br />container. <br />Exfre Ice Bugs & Fcod CeMtmra must be ■ <br />3/dr»d 6 Inches off of the grcundl W <br />—3! J <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (itfood is used the following day, maintain below 41 °F temperature):
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