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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 VENDOR’S APPLICATIOI <br />$ <br />1. <br />2. <br />)____Phone: <br />13. <br />6 <br />4. <br />KJ- lj <br />5. <br />6. <br /> Approved bottled water. <br />Other (specify): <br />'7. <br />2 <br />’ 1 <br />Alternate: ( <br />J <br />mzfther (specify): <br />Note: The only operations not required to provide enclosed booths are those w <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 <br /> On-^ite hose bib that is connected to a potable water source. <br />Brother (specify): <br />Electricity is provided for my booth’s use: EJ Yes 0^No^" J <br />I am providing a booth with the following: (to protect my unpackaged food and food-pr <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar <br />screening, completely enclosing open food areas. It will also have a smooth and <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate <br />areas from the public. f ' J <br />AH food vendors (both for profit and non-profit) are required to return a signed and complete <br />the festival coordinator three (3) weeks prior tot^is event. . <br />1. Name of Event: ^7^ <br />The following is information about my oiwhization/business: <br />Name of organization/business: s <br />Address: /c? 7 <br />(f^ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: B^es No <br />All food is prepared on-site or is from approved commercial facilities: Yes No z <br />’ . Name of facility: -- Phone: (^^^ <br />Address of facility: . Z-/A€ &-- -------------
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