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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LOCUST
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1221
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1600 - Food Program
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PR2400355
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
4/3/2025 11:43:44 AM
Creation date
4/3/2025 11:43:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR2400355
PE
1608 - CLASS A COTTAGE FOOD-DIRECT SALES
FACILITY_ID
FA0001384
FACILITY_NAME
INK AND FLOUR SOURDOUGH BAKERY
STREET_NUMBER
1221
Direction
W
STREET_NAME
LOCUST
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\ymoreno
Supplemental fields
Site Address
1221 W LOCUST ST LODI 95240
Tags
EHD - Public
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Docusign Envelope ID: 6601963D-OF4F-4EF1-8AB3-9A6520EF9ECD <br />Dried or Dehydrated Dried Vegetarian- <br />Vegetables Based Soup Mixes <br />Sweet Sorghum Roasted Coffee <br />Syrup (Beans/Grounds) <br />Fried or Baked <br />Donuts and Waffles Dried Hot Chocolate <br />El Vegetable and Potato Chips <br />Chocolate Covered Nonperishable Food <br />El Fruit Infused Balsamic Vinegar <br />LII 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 Regulations <br />http://www.accessdata.fda.qov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Food Descriptions: <br />*sourdough Butter cookies. INGREDIENTS: wheat, sea SALT, water, <br />sugar, vanilla, butter <br />*Banana chocolate chip muffins. INGRFDIFNTS: wheat, sea SAIT, <br />brown sugar, vanilla, butter, egg, baking soda, baking powder. <br />Lemon blueberry muffins. INGREDIENIS. wheat, sed SALT, sugar, <br />vanilla, butter, egg, baking soda, baking powder, leomon, <br />blueberries <br />-c ed dr jdldpeno sourdough. INGREDIENTS. W edt, sed SALT, <br />jalapenos, cheddar cheese. <br />*sourdough Tortillas. INGREDIENTS: wheat, sea salt, olive oil. <br />Lemon blueberry sourdough. INGREDIENTS. WheaL, sea SALT, water, <br />blueberries, Lemon. <br />*sourdough lemon blueberry scones. INGREDIENTS: wheat, sea SALT, <br />milk, butter, blueberries, lemon, baking powder, egg <br />EHD 16-27 6/29/2023 2 CFO REG/PERMITTING FORM
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