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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0546228
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
11/12/2020 2:04:35 PM
Creation date
10/30/2020 2:14:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0546228
PE
1608
FACILITY_ID
FA0026169
FACILITY_NAME
MAYA'S BAKERIA
STREET_NUMBER
126
Direction
W
STREET_NAME
FAUNA
STREET_TYPE
CT
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
01
SITE_LOCATION
126 W FAUNA CT
P_LOCATION
03
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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(i A <br /> Ns <br /> O n Q I � IN <br /> Environmental Health Department <br /> JJ—HCO U NH T YlJ—`I <br /> Example: <br /> MADE IN A HOME KITCHEN <br /> Permit#: 12345 <br /> Issued In county: County name <br /> Chocolate Chip Cookies With Walnuts <br /> Sally Baker <br /> 123 Cottage Food Lane <br /> An}�vhere.CA 900LX <br /> Ingredients: Enriched flour(\\Teat flour,uuachn,reduced iron,tluanune. <br /> mononitrate,riboflavin and folic acid),butter(nulk,sail),chocolate clips <br /> (sugar,chocolate liquor,cocoa butter.butterfat(milk), walnnts,sugar,eggs. <br /> salt,artificial vanilla extract,baking soda. <br /> Contains:Wheat,eggs,milk,soy,walnuts <br /> Net Wt.3 oz.(85.049g) <br /> Note:For the Issued in County"-Identify the Jurisdiction(city/county)where you are obtaining approval. <br /> 6. Disposal of Waste: <br /> Please check what type of treatment is used to dispose of waste <br /> ❑ Public Sewer Service ❑ Private Septic System <br /> In the event of septic system failure or plumbing problem,you are required to notify San Joaquin County Environmental Health Department <br /> immediately. <br /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> E lName of Public Water System or Community Services District: <br /> ❑ Private Water Supply", Identify the source (well, spring, surface, etc.): <br /> Private Water Supply: Initial Water Quality Results <br /> Check boxes below if initial water testing has been completed. <br /> All testing must be done at a State Certified Laboratory. Either attach lab results or provide name of lab,date& <br /> results in space provided next to type of test. <br /> '(Testing frequency for transient Non-Community Water Systems after initial testing) <br /> ❑ Bacteriological Test(quarterly`): <br /> ❑ Nitrate Test(yearly`): <br /> ❑ Nitrite Test(every 3 years'): <br /> "Additional Information may be required if food Is prepared from a home with a private water supply—check with local jurisdiction, <br /> 8. Food Processor Course: Initial if you agree to abide by the following: <br /> Within 3 months of being approved to operate by the Environmental Health Department, please provide proof <br /> of completion of the California Food Handler course in lieu of the California Department of Public Health <br /> (CDPH)food processor course. <br /> For more information see CDPH website www.cdph.ca.gov/programs/Panes/fdbCottaneFood.aspx <br /> 4 of 5 <br /> EHO 16-27 6128117 CFO REGMERMITTING FORM <br />
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