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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 handler certification for owner and each individual that were not submitted with initial <br /> application (including family members and/or employees). nn <br /> 7. Delivery Limitation: Initial if you agree to abide by the following: l J� <br /> I understand that I may accept orders and payments via the internet, mail or phone. However, all"Class <br /> A"and "Class B" CFO products must be delivered directly (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 /> 8. Owner's Statement: <br /> I, L.tAJA� - D • , agree to grant access to the local health <br /> department to conduct an insikction of my cottage food operation (mark one) <br /> ❑ "Class A": In the event of a consumer 1�f'°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 /> I, �Cl 17 �Qjzt f agree to notify the San Joaquin County <br /> Environmental Health Dep rtment 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 /> O e Signa re Print Name at <br /> EHD 16-297127117 2 CFO REG/PERMITTING RENEWAL FORM <br />
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