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COMPLIANCE INFO_2023
EnvironmentalHealth
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1600 - Food Program
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PR0548713
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
9/28/2023 4:05:34 PM
Creation date
9/28/2023 4:04:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0548713
PE
1608
FACILITY_ID
FA0027882
FACILITY_NAME
LILLY'S BAKERY
STREET_NUMBER
17880
STREET_NAME
SILVER SPRINGS
STREET_TYPE
WAY
City
LATHROP
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
17880 SILVER SPRINGS WAY
P_LOCATION
07
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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Dried or Dehydrated <br />Vegetables <br />Sweet Sorghum <br />Syrup <br />Fried or Baked <br />Donuts and Waffles <br />0 Dried Vegetarian- 0 Vegetable and Potato Chips Based Soup Mixes <br />El Roasted Coffee Yr Chocolate Covered Nonperishable Food (Beans/Grounds) <br />El Dried Hot Chocolate E Fruit Infused Balsamic Vinegar <br />&I-bread , 0416,v c_f-€_ coJ \\se, s <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 Regulations <br />http://www.accessdataida.goviscripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Food Descriptions: <br />Pon Cake./ s coo \Ci PS ( S-LCIVC(A c.&.) -0‘ killoffr,) <br />0(010„4-e cove{ed coo kieS ()JAI S1)-01 e.)I v) <br />\ LAI \Dread Loi-h i-Mouj Gsacc cpCe <br />r\co _ q.4u'ecf pcAchfi tl UJcii1 çpcAi 1ovg.) Spice) <br />b otoqJ t (x{s & p <br />C \roNANe, 9)6‘e1s <br />Other <br />E HO 16-27 6/29/2023 2 CFO REG/PERMITTING FORM
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