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COMPLIANCE INFO_2023
EnvironmentalHealth
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1600 - Food Program
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PR0544073
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
3/22/2023 10:25:56 AM
Creation date
3/22/2023 10:23:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0544073
PE
1608
FACILITY_ID
FA0025069
FACILITY_NAME
SHELLY'S SUGAR SHAK
STREET_NUMBER
1721
STREET_NAME
LARAMIE
STREET_TYPE
WAY
City
STOCKTON
Zip
95209
CURRENT_STATUS
01
SITE_LOCATION
1721 LARAMIE WAY
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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SANJ O A Q U I N Environmental Health Department <br />ALJ 7 Y <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: <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 />11. Owner's Statement: <br />I, t J''1 Al � - agree to grant access to the local health department to <br />conduct an ins ction of my cottage fco operation (mark one) <br />"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 />complaint or food -home <br />I. U 1 , agree to notify the San Joaquin County <br />Environmental ealth Department ri to modifying my food list, type of operation, and/or method of <br />selling, distributing, or otherwise pro g my CFO products to the consumer or retailers, regardless of <br />whether the prod u sol , consigned, or given away. <br />Z161, <br />OwneWa Print <br />5 of <br />EHD 16-27 6129117 <br />12 22. 2U <br />Date <br />CFO REGIPERMITTING FORM <br />
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