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COMPLIANCE INFO_2022
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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CHURCH
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835
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1600 - Food Program
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PR0545498
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
7/19/2022 4:51:55 PM
Creation date
7/19/2022 4:47:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0545498
PE
1608
FACILITY_ID
FA0025827
FACILITY_NAME
KNEADS PROOF
STREET_NUMBER
835
Direction
S
STREET_NAME
CHURCH
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
835 S CHURCH ST
P_LOCATION
02
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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REGISTRATIONIPERMITTING RENEWAL FORM <br />CFO Business <br />- Busln <br />-`n: acn ^r V o1 ON7 <br />e1/ r-eY 1 G1 ft S k :l -Cr Date. �t <br />CFO Physical Address: CFO City: CFO Iq <br />L <br />' J L1LtAL ] Si- LociI 9�z�c <br />Website (II applicable):Teleptwne: <br />vvvvw. neaJsprocr-.ror 20(1-(pyli-6zq <br />1. Categories: <br />X "Class A" (Direct Sales Only) $155 ❑ 'Class B" (Direct & Indirect Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: 8.4 <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-bome illness. <br />3. Products: <br />Provide a list of all products you are preparing. If preparing jams, jellies, or fruit butters include a list of <br />ingredients (attach separate page if needed). <br />Food List: <br />4. Product Labeling: <br />Attach two labels to this form for two of your CFO products (only one label is required if only one product is <br />made). <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water ❑ Private Well' <br />'If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />6. Food Processor Course: <br />.,......., r,.,.a 6....ni,..and -k inAkArinnl unnt wprp Mt Rllhmltted with Initial aDDllcation <br />
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