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SAN JOAQUIN <br />CTCti N y <br />Environmental Health Department <br />7. Owner's Statement: <br /> agree to grant access to the local health department to conduct an inspection of my Oottage food operation (mark one) <br />14] "Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />D "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />i7-1:;scQieVr CaCkc , agree to notify the San Joaquin County Environmental Health Depariment prior to difying 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, consigned, or given away. <br />rksaorec. C_ <br />Owner's St at re <br /> <br />U2 ‘rtelit ge <br />Print Name <br /> <br />6 e)1605 <br />Da e( <br /> <br />,MADE IN: A HOME KITCHEN <br />Permit ti PT0028038 <br />Issued in: San Joaquin County <br />Lemon Pound Cake <br />Casey's Got Cakes <br />163 \ Santa Clara Dr. <br />Mountain House, Ca. 95391 <br />Ingredients: Enriched flour (Wheat flour, niacin, reduced iron, <br />thiamine, mononitraie, riboflavin and folic acid), butter (milk. salt), <br />tsugar, eggs. fresh lemon juice, artificial lemon extract, confectioner's <br />snip- (sugar, cornsbirclit <br />Contains: Wheat, eggs, milk <br />Net Wt. 2.998 oz. (85g) <br />MADE IN A HOME KITCHEN <br />Permit # PT0028038 <br />Issued in: San Joaquin County <br />7-Up Pound Cake <br />Casey's Cot Cakes <br />163W. Santa Clam Dr. <br />Mountain House, Ca. 95391 <br />Ingredients: Enriched flour (Wheat flour, niacin, reduced iron, <br />niononitrate, riboflavin and folic *acid), butter (milk, salt), <br />sugar, eggs, 7-Up (filtered carbonated water, high fructose corn syrup, <br />ruric acid, potassium citrate, natural flavors, calcium disodium (to <br />ptotect IVO r), fresh lemon juice, artificial lemon extract, <br />onfectioner's sugar (sugar, cornstarch) <br />Contains: Wheat, eggs, milk <br />Net Wt. 2.998 oz. (85g) <br />2 of 2