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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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MAY/29/201-5/FRI 11:32 AM ■RC FAX No. 9164800282 P. 003WYNSPRI. <br />'Detergent, bleach, and wiping cloths (cleaning towels). <br /> Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br /> Tub to store wiping cloths in bleach solution measuring lOOppm. <br />12. <br />13. <br />v ' "Important** <br />14.- <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />■ Propane Tank <br />Bleach and water <br />Firo ExtlnQuiaher <br />Page 6 of 11 TEMP EVENT APREHD 16-02 <br />1174/14 <br />10. lam 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 4 TF temperature): <br />Stemo w/ChEfftrs <br />Extra <br />Water <br />Garbage <br />Can <br />5 Gai Hand wash <br />Wastewater Container <br />r <br />• Sarytizerbucket- <br />Maach & water ftw <br />storing Wiping CtoffiS <br />Sooth must bo on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />' 7 <br />lee Cooler ;■ <br />Haia'uBBnwater <br />Signature <br />. r <br />Soap and Water <br />L___ <br />Rinse Water <br />Title <br />SUce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />pother (specify) J <br />11, lam providing the following items within my booth for the sanitary cleaning of food preparation utensils; <br />^^Ttree^o mpartment sink. <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 />Ioq Bags & Food Containws mustbo S <br />sterad 6 Indies off cd the gnMndl Iffi <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />. 0Water supply dispenser with warm water at a minimum of 100“F (i.e. 5-20 gallon container with spigot). <br />J^fOne separate tub (bucket or basin) far the collection of rinse/wastewater. <br /> ^fPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operatigni <br />1 ' “ TilUy <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 />Completed by:
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