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SMUOAOUIN <br />CFO Business Name <br />label is required if only one product is <br />T 209 468-3420 | F <br />?^0S4^ <br />CFO Zip <br />^^^3.__ <br />6 Food Processor Course: <br />1868 E. Hazelton Avenue | Stockton California 95205 | <br />15 <br />CFO Physical Address <br />Website (If applicable) <br />Environmental Health Department <br />!ach individual that were not submitted with initial application <br />209 464-0138 | www sjcehd com <br />ingredients (attach separate page <br />Food List r <br />4- ZSSS-onCootyourCrOproductslomyone <br />made) <br />Owner Name . <br />CFO City <br />------ <br />Telephone <br />□ “Class B" (Direct & Indirect Sales) S486 <br />3' <br />1. Categories: <br />-class A" (Direct Sales Only) $186 <br />cause of food-borne illness. <br />;«--5 SANvJOAOUIN <br />-------COUNTY <br />Greatness grows here. <br />Dale