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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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YORKTOWN
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1959
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1600 - Food Program
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PR0546102
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
10/28/2021 1:32:12 PM
Creation date
9/28/2021 1:40:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0546102
PE
1608
FACILITY_ID
FA0026070
FACILITY_NAME
GOLDEN MOON BAKERY
STREET_NUMBER
1959
STREET_NAME
YORKTOWN
STREET_TYPE
DR
City
LODI
Zip
95242
CURRENT_STATUS
01
SITE_LOCATION
1959 YORKTOWN DR
P_LOCATION
02
QC Status
Approved
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SJGOV\jcastaneda
Tags
EHD - Public
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S (� AI J 0 Q (�I I I N Environmental Health Department <br /> ti 1�_ I i NII TVYv <br /> 7. Delivery Limitation: Initial if you agree to abide by the following: /VV1 <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, Mair I(1 V W)Mro A f II�Y O , agree to grant access to the local health department to <br /> conduct an inspectio of my cottage food operation (mark one) <br /> u "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, <br /> Roo, V AV U qAy mf 4 p 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 /> /tJA Marl V� huURfd6f �mvn 00.112021 <br /> Owner's Signature Print N me Date <br />
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