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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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10. <br /> Three compartment sink. <br />OR <br />12. <br />13.Name:•esponsible pen ms. <br />14. Completed by: <br />Signa^H^ <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Soap and Water Rinse Water- <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />11 <br />EHD 16-02 <br />11/4/14 <br />[ Q Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />s olution (one tablespoon of bleach per gallon of water). • <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 /> Refrigerator <br /> Ice bath and tubs <br />Stemo w/Chaffmg <br />Dish <br />Extra, <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket <br />bleach .& water for <br />storing wiping doths <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />pjQ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />• Paper towels and pump-style soap container. <br />[; J Detergent, bleach, and wiping cloths (cleaning towels). <br />Jest strips to measure sanitation levels for bleach solution measuring 10Oppm. <br />^.Tub to store wiping cloths in bleach solution measuring lOOppm. <br />I am providing the following for adequate hand washing facilities, but. separate from utensil wash within my <br />booth: <br />5-20 Gal. <br />Hand wash Water <br />tU <br /> I u <br /> Ice chests <br />• Refrigerated truck <br /> Other (specify), <br />11. . lam providing the following items within my booth for the. sanitary cleaning of food preparation utensils: A* <br />“Important** <br />Title <br />^L| <br />Propane T§nk <br />ie present in booth during all hours of operation: ,/ <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 dll hours of <br />preparation and operation. Return original to festival coordinator three weeks, prior to <br />this event. <br />Ex/ra Ice Bags & Food Containers must be E <br />stored 6 inches off of the ground! pi <br />■: —■ <br />Garbage <br />Can <br />r---------------------- <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp.
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