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COMPLIANCE INFO_2021
EnvironmentalHealth
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1600 - Food Program
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PR0547084
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COMPLIANCE INFO_2021
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Last modified
9/28/2021 11:30:48 AM
Creation date
9/28/2021 8:33:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0547084
PE
1608
FACILITY_ID
FA0026699
FACILITY_NAME
KAI'S KITCHEN 808
STREET_NUMBER
1263
Direction
S
STREET_NAME
PALERMO
STREET_TYPE
LN
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
01
SITE_LOCATION
1263 S PALERMO LN
P_LOCATION
03
QC Status
Approved
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SJGOV\jcastaneda
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EHD - Public
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SAN JOAQUIN <br />( OU NTY <br />❑ Sweet Sorghum ❑ Roasted Coffee <br />Syrup (Beans/Grounds) <br />❑ Fried or Baked ❑ Dried Hot Chocolate <br />Donuts and Waffles <br />Environmental Health Department <br />❑ Chocolate Covered Nonperishable Food <br />❑ Other_ <br />Do not contain eggs, cream, or cream cheese <br />" If preparing jams, jellies or fruit butters, include a list of ingredients (attach separate page if needed). These items <br />must comply with standards described in Part 150 of Title 21 of the Code of Federal <br />Regulations http://www.accessdata.fda.oov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Food Descriptions: <br />Dessert Bars (similar to lemon bars) <br />Tropical fruit and traditional American toppings baked on top of shortbread cookie, graham cracker cookie, <br />or macadamia nut/pecan soft crusts. Flavoring is puree or canned fruit based and no fresh fruit used. <br />Flavors include: Guava, Passion Fruit, Pineapple, Coconut, Chocolate, and Pumpkin. <br />Pies <br />Key Lime Pie with homemade graham cracker crust kN� sob 0'. <br />Chocolate Coconut Pie with homemade macadamia nut crust r'\ <br />Butter Mochi <br />A soft, chewy, buttery treat made with sweet rice flour and rich coconut milk. <br />Flavors include: Hawaiian Style (original/plain), Guava, Passion Fruit, Taro, Matcha (Green Tea), and Chocolate. <br />Chiffon Cakes (similar to angel food cakes) <br />Light, fluffy, and pillowy soft cake. <br />Flavors include: Guava, Passion Fruit, Coconut, Pineapple, Kona Coffee and Chocolate. <br />2 of <br />EHD 16-276129/17 CFO REG/PERMITTING FORM <br />
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