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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0548816
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
1/4/2024 2:58:13 PM
Creation date
1/4/2024 2:57:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0548816
PE
1608
FACILITY_ID
FA0027965
FACILITY_NAME
EVENTS BY NICKI
STREET_NUMBER
17214
STREET_NAME
BOWLING
STREET_TYPE
CT
City
LATHROP
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
17214 BOWLING CT
P_LOCATION
07
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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fl Nitrite Test (every 3 years*): <br />**Additional information may be required if food is prepared from a home with a private water supply — check with local jurisdiction. <br />Food Processor Course: Initial if you agree to abide by the following: <br />Within 3 months of being approved to operate by the Environmental Health Department, please <br />provide proof of completion of the California Food Handler course in lieu of the California Department <br />of Public Health (CDPH) food processor course. <br />For more information see CDPH website www.cdph.ca.gov/procirams/Paqes/fdbCottacieFood.aspx <br />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 <br />including a family member or household member of the cottage food operator, working within the <br />registered or permitted area of a private home where the cottage food operator resides and where <br />cottage food products are prepared or packaged for direct, indirect, or direct and indirect sale to <br />consumers. <br />Delivery Limitation: 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. Direct and <br />Indirect sales may be fulfilled in person, via mail delivery, or using any other third-party delivery <br />service throughout the state of California only. <br />Owner's Statement: <br />(--(‘2 k .I 0,e %-.--,Aikir) \-)Or`-k , agree to grant access to the local health <br />department to conduct an inspectio1 of my cottage food operation (mark one) <br /> <br />[9Class A": In the event of a consumer "Class B": For regular annual facility <br /> <br />complaint or reported food-borne illness inspections and in the event of a consumer <br />complaint or food-borne <br />c , agree to notify the San Joaquin County <br />Environmental Health Department pitior to modifying my food list, type of operation, and/or method <br />of selling, distributing, or otherwise providing my CFO products to the consumer or retailers, <br />regardless of whether the product is sold, consigned, or given away. <br />\)zC,1 )7c.2_:5 <br />Print Name ate Owner's Signature <br />5 CFO REG/PERMITTING FORM EHD 16-27 6/29/2023
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