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COMPLIANCE INFO 2018-PRESENT
Environmental Health - Public
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MOKELUMNE RIVER
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1600 - Food Program
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PR0542487
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COMPLIANCE INFO 2018-PRESENT
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Last modified
1/17/2019 3:37:27 PM
Creation date
12/10/2018 8:37:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2018-PRESENT
RECORD_ID
PR0542487
PE
1609
FACILITY_ID
FA0024421
FACILITY_NAME
MY NANA'S COOKIES
STREET_NUMBER
151
STREET_NAME
MOKELUMNE RIVER
STREET_TYPE
DR
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
151 MOKELUMNE RIVER DR
P_LOCATION
02
QC Status
Approved
Scanner
WNg
Supplemental fields
FilePath
\MIGRATIONS3\M\MOKELUMNE\151\PR0542487\COMPLIANCE INFO 2018-PRESENT.PDF
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EHD - Public
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❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> Sweet Sorghum Roasted Coffee <br /> ElSyrupEl (Beans/Grounds) ElChocolate Covered Nonperishable Food <br /> Fried or Baked <br /> ❑ Donuts and WafflesElDried Hot Chocolate E] Fruit Infused Balsamic Vinegar <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 Regulations <br /> htti)://www.accessdata.fda.gov/scripts/cdrh/cfdocs/efCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> eke 1 Goods . Cu <br /> Cookies c .pCa.kes , e,'�'C <br /> IZoyc�l i�c wig merurue. powder- nof-Fresh eag LA&e-s <br /> EHD 16-27 7/27/17 2 CFO REG/PERMITTING FORM <br />
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