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'4 <br />Qanlity <br />4.4.4 trf <br />Actikir (606442/1. <br />Ingredients <br />Enriched bleached <br />flour, (niacin, reduce <br />iron, thiamin, mono <br />nitrate, riboflavin, fo <br />acid only), vegetable;! <br />oil, sugar, eggs, bald <br />soda, baking powder, <br />almonds, pure anise <br />extract, pure anise 1,) <br />seeds <br />Contains: eggs, almon4s <br />Earl W. Harris & <br />Elida Manna Harris <br />barris489@comcas <br />489 Kirst Drive <br />Woodbridge, CA 9 <br />San Joaquin County <br />Permit # PT002.584 <br />(209) 333-0801 <br />' SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY— <br />7. Owner's Statement: <br />, <br />bAr 4-arri-6 , 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 111 "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 /> , 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 />co.: 4d, car given ay. <br />1 2 / 4e - Owner's Signature <br />6)- Z); Print Name <br />EHD 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM