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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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TEMPORARY food FACILITY (TFF) INFCIRMATIONSHEET <br /> <br />Name of Event <br /> Date(s) of Event <br />Location of Event <br />Phone <br />Number of workers <br />of cooking equipment. A list <br />1. <br />2. <br />hand-wash station in your booth? <br />3. <br />Initial <br /> Date <br /> <br />Name of Food Booth (TFF) <br />TFF Person in Charge (PIC) <br />Contact Phone for day of event <br />< J; t \ <br />\l yJOtA-fS <br />a ware-wash station? <br />Signature _ <br />Title/Position <br />- ii <br />• w_________ <br />JlaAxI <br />Event Organizer <br />Approximate number of meals to be served <br /> ZSZX. (example: restaurant, ehumn. on-site) SCOOfiS <br /> , Where will the extra food be stored at the end of the day? YMSClBL.------------------------ <br />important notes <br />Contact your local fire jurisdiction regarding applicable fire code requirements for use <br />of phone numbers has been provided on page 17 of this packet. <br />Complete the "TFF Self-Inspection Checklist" before beginning to operate and reep it avaHable for inspector <br />review. (See pages 4-5 of packet) <br /> [ Complete the following questions:---------------------------------- -------------------------------------- <br />i 1 What is the final cooking temperature for chicken ? <br />Phone~]lb ■ 63-A'Q- <br />W/hat is the final cooking temperature for chicken? <br />_______I / <br />2. Do you need to set up a <br />N eS_______ <br />What do you need to bring to set up a hand-wash station? <br />4. Do you neld to set up a <br />2nd Phone <br />Environmental Management Department • 10590 Armstrong Avenue, Ste B, Mather. CA 95655 ■ PH: (916) 875-8440 Fax. ( 916) 875-8513 <br />www.emd.saccounty.net <br />- >1^ <br />warewash station? What do you need to bring to set up <br />-------------------------------------- <br />5 At what temperature should ^old foods be kept? TbXcA* j--------------- <br />6. At what temperature should hot foods be kept? \ \ ----------- <br />7 Is it ok to make food at home prior to the event for serving from r^iKfSXZS-——---------------- <br />8. Do you have a Cottage Food registration or permit? —. <br />I have received a copy of the “Temporary Food Facility Operating Requirements” including the Self <br /> Inspection Checklist, and agree to follow these requirements. <br />I have included a site plan that indicates the proposed layout of equipment, food preparation tables, food <br />storage, warewashing, and handwashing in my TFF. <br />I have attached a completed TFF menu sheet. <br />I have read and understand the No Bare Hand Contact with Ready-to-EEat Foods policy
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