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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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ELLIOTT
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23216
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1600 - Food Program
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PR0546753
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
5/11/2022 4:15:16 PM
Creation date
5/11/2021 2:14:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0546753
PE
1608
FACILITY_ID
FA0026501
FACILITY_NAME
ELLIOTT ROAD BARN
STREET_NUMBER
23216
Direction
N
STREET_NAME
ELLIOTT
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
23216 N ELLIOTT RD
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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a <br /> S ((({N,rI 0 (I Q U I N Environmental Health Department <br /> COUNTY 'V Inluding <br /> 9. Employee: Initial if you agree to abide by the followingI understand that I may not have more than one full-time equivalent cottage food employee, noa <br /> family member or household member of the cottage food operator,working within the registered or permitted <br /> area of a private home where the cottage food operator resides and where cottage food products are prepared <br /> ' d or packaged for direct,indirect,or direct and indirect sale to consumers. tiass <br /> 10. Delivery Limitation: Initial if you agree to abide by the following:I understand that I may accept orders and payments via the internet, mail or phone. However, all 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 /> 11. Owner's Statement: <br /> agree to grant access to the local health department to <br /> conducl an Inspection of my cottage food operation(mark one) <br /> X"Class A": In the event of a consumer ❑ "Class B": For regular annual facility <br /> complaint or reported food-borne illness inspections and In the event of a consumer <br /> r complaint or food-bome <br /> agree to notify the San Joaquin County <br /> Environmental Health Department prior to modifying my food list,type of operation, and/or method of <br /> selling, distributing,or otherwise providing my CFO products to the consumer or retailers, regardless of <br /> whether the product is sold,consigned,or given away. <br /> Ju <br /> Owner's Signature Print Name Date <br /> I / <br /> 5 of <br /> EHO 16-27 629117 CFO REGIPERMnTING FORM <br /> I I <br />
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