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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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CHURCH
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835
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1600 - Food Program
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PR0545498
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
4/24/2024 11:24:47 AM
Creation date
4/24/2024 11:24:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0545498
PE
1608
FACILITY_ID
FA0025827
FACILITY_NAME
KNEADS PROOF
STREET_NUMBER
835
Direction
S
STREET_NAME
CHURCH
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
835 S CHURCH ST
P_LOCATION
02
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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Employee: Initial if you agree to abide by the following: <br />Delivery Limitation: Initial if you agree to abide by the following: <br />0 Nitrite Test (every 3 years): <br />*Addibonal intormation may he required it food Is ',mewed front a home wok n priyale water supply - check with local jurisdiction. <br />8. Food Processor Course: Initial if you agree to abide by the following: <br />Within 3 months of beina 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 rnore information see CDPH website www.cdoh.ca.Rek/Drograms/Panes/rdbCONafleFOOda317x <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 />I understand that I may accept orders and payments via the intemet. 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 />• <br />11. Owner's Statement: <br />gref7d4 CWieti-6fr- . aaree to grant access to the local health <br />department to conduct an inspection of my cottage food operation (mark one) <br />'Class A": In the event of a consumer 0 "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-borne <br />I, gr e7la OS!? &/f , agree to notify the San Joaquin County <br />Environmental Health Department prior 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 />Print Name Date A-2.2,--La; <br />Owner's Signature <br />SA a f-cr- ‘2. -2 /--,,zy <br />5 END 16-27 6/292023 CFO REG/PERMITTING FORM
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