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COMPLIANCE INFO_2016-2019
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1600 - Food Program
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PR0541095
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COMPLIANCE INFO_2016-2019
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Entry Properties
Last modified
12/11/2020 3:16:56 PM
Creation date
7/2/2019 9:00:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016-2019
RECORD_ID
PR0541095
PE
1609
FACILITY_ID
FA0023531
FACILITY_NAME
MOM'S BOMB
STREET_NUMBER
3925
STREET_NAME
WILLIAM
STREET_TYPE
CT
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
3925 WILLIAM CT
P_LOCATION
01
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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E <br /> F - <br /> 6. Food Processor Course: <br /> Attach food handier certification 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: <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 directs (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 /> agree to grant access to the local health <br /> ' department to conduct an inspection of my cottage food operation (mark one) <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 /> E. food-borne illness <br /> agree to notify the San Joaquin County <br /> Environmental Health Departmenl 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 /> C ,4 <br /> i <br />` Owner'sria lure- Print Name Date <br /> I <br /> i <br /> k <br /> y <br /> 'EHD 16-29 6/2912015 2 CFO REG/PERMITTING RENEWAL FORM <br /> ' l <br />
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