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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0538891
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
5/6/2021 3:31:54 PM
Creation date
4/21/2021 4:30:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0538891
PE
1609
FACILITY_ID
FA0022345
FACILITY_NAME
KAY'S CREATIONS
STREET_NUMBER
535
Direction
W
STREET_NAME
CANCION
STREET_TYPE
CT
City
MOUNTAIN HOUSE
Zip
95391
APN
25442004
CURRENT_STATUS
01
SITE_LOCATION
535 W CANCION CT
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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SJGOV\jcastaneda
Tags
EHD - Public
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SAN:;J 0 A Q U IN Environmental Health Department <br />COUNTY - <br />7. Delivery Limitation: Initial if you agree to abide by the following: X� <br />I understand that I may accept orders and payments via the internet, mail or phone. However, all "Class A" and <br />"Class B" CFO products must be delivered directly (in person) to the customer. The CFO products may not be <br />delivered via the United States Postal Service, UPS, FedEx, or using any other indirect delivery method as <br />deliveries are regulated by, and subject to, CDPH registration and state and federal requirements. <br />8. Owner's Statement: <br />I, VWV�4 1 *A4 " , agree to grant access to the local health department to <br />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 />food -borne illness <br />I, KA99 1� , agree to notify the San Joaquin County Environmental <br />Health Department prior to modifying my food list, type of operation, and/or method of selling, distributing, or <br />otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br />consigned, or given away. <br />O vers Signature <br />Print Name <br />2 of <br />-112- <br />2 <br />12- <br />
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