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COMPLIANCE INFO_2022
EnvironmentalHealth
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1600 - Food Program
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PR0547637
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
5/16/2022 9:48:16 AM
Creation date
5/2/2022 8:11:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0547637
PE
1609
FACILITY_ID
FA0027120
FACILITY_NAME
MY COOKIE
STREET_NUMBER
469
STREET_NAME
GLENBRIAR
STREET_TYPE
CIR
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
469 GLENBRIAR CIR
P_LOCATION
03
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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SANJ O A Q U I N Environmental Health Department <br />OUNTY- <br />9. Employee: Initial if you agree to abide by the following: <br />I understand that I may not have more than one full-time equivalent cottage food employee, not including a <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 />or packaged for direct, indirect, or direct and indirect sale to consumers. <br />10. Delivery Limitation: <br />Initial if you agree to abide by the following: 4/ <br />I understand that I may accept orders and payments via the internet, mail or phone. However, all "Class K 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 />I, Es{ et4 Moreno –Caf z41k '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 <br />complaint or reported food -borne illness <br />"Class B": For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-bome <br />I, eS�e LSI► `D%�n 0 `l, a �Zq tel' , 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 />E54'C(q 3/22-/ 2 Z• <br />5of5 <br />EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />
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