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COMPLIANCE INFO_2016-2019
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1600 - Food Program
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PR0540811
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COMPLIANCE INFO_2016-2019
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Entry Properties
Last modified
9/29/2020 4:45:40 PM
Creation date
4/30/2019 10:51:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016-2019
RECORD_ID
PR0540811
PE
1609
FACILITY_ID
FA0023332
FACILITY_NAME
BLOOM BAKERY
STREET_NUMBER
1835
STREET_NAME
PIEDMONT
STREET_TYPE
DR
City
MANTECA
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
1835 PIEDMONT DR
P_LOCATION
04
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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6. Food Processor Course: <br /> Attach food handle r.certi ficati on for owner and each individual that were not submitted with initial <br /> application (including family members and/or employees). <br /> 7. Delivery Limitation: Initial if you agree to abide by the following: 1� <br /> I understand that I.may accept orders and payments via the internet, mail or phone. However, all "Class <br /> A" and "C[ass B" CFO products must be delivered direct/ (in person) to the customer. The CFO products <br /> may not be delivered via the United States Postal Service, UPS, FedEx, or using any other indirect <br /> delivery method as deliveries are regulated.by, and subject to, CDPH registration and state and federal <br /> requirements. <br /> B. Owner's Statement: , <br /> -1, L_Lnda� V_ agree_torgr=ant accpssAo the:local-hea#tb - <br /> d partrrient to conduct ari ins ction of my cottage food operation (mark one) <br /> - I <br />' ❑ "Class A": In the event of a consumer "Class B": For regular annual facility inspections <br /> complaint or reported food-borne illness and in the event of a consumer complaint or <br /> food-borne illness <br /> agree to notify the San Joaquin County <br /> Environmental Health DepUrtment prior to modifying my food list, type of operation, and/or method <br /> of selling, distributing, or otherwise providing my CFO products to the consumer or retailers, <br /> regardless of whether the product is sold, consigned, or given away. <br /> i <br /> D. <br /> Owner's Srgnat e Print Name Date <br /> f <br /> I <br /> EHD 16-29 6/29/2015 2 CFO REG/PERMITTING RENEWAL FORM <br /> i <br /> L - <br />
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