|
Environmental Health DA01.11111111111nt
<br />SAN JOAQUIN
<br />-COUNTY
<br />Delivery Limitation: Initial if you agree to abide by the following: My
<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 />Owner's Statement:
<br />MU ly\ 0 P-1' , agree to grant access to the local health department to
<br />conduct an inspection of my cottage food operation (mark one)
<br />i"Class A": In the event of a consumer
<br />complaint or reported food-borne illness
<br />"Class B": For regular annual facility inspections
<br />and in the event of a consumer complaint or
<br />food-borne illness
<br />1, MOW -TAN/100 ,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 />consigned, or given away.
<br />M(C4.1-elAt ‘/-t-IV 510 2#4
<br />
<br />Ow:. _r's Signature
<br /> Print Name Date
<br />Made in a home facility
<br />Permit ID # P100213634
<br />Issued in San Joaquin County
<br />KUYS COOKIES
<br />CHOCOLATE CHIP
<br />Ingredients: all purpose flour
<br />(bleached wheat flour, enriched
<br />bleached wheat flour. niacin,
<br />reduced iron, thiamine mononitrate,
<br />riboflavin, folk acid, malted barley
<br />flour). baking powder, granulated
<br />sugar, brown sugar, eggs, semi sweet
<br />chocolate chips, buttecsalt, cream,
<br />vanilla extract (vanilla bean extractives
<br />in water, alcohol (35%)
<br />Produced In the same equipment as tree nuts
<br />and nuts
<br />Contains wheet, eggs and milk
<br />Follow us on 10
<br />kuyes_cookles
<br />Made In a Home Kitchen
<br />Permit IIPT0028634
<br />Issued in San Joaquin County
<br />Vegan GF Snickerdoodle
<br />Kuya's Cookies
<br />Ingredients: Gluten-free flour (Sweet White Rice Flour,
<br />Whole Grain Brown Rice Flour, Potato Starch, Whole Grain
<br />Sorghum Flour, Tapioca Flour, Xanthan Gum)„ sugar, vegan
<br />butter (Organic Coconut oil, Organic Cultured Cashew Milk
<br />(Filtered Water, Organic Cashews, Cultures), Filtered Water,
<br />Organic Sunflower Oil, Organic Sunflower Lecithin, Sea Salt),
<br />Egg Replacer (Potato Starch, Tapioca Flour, Baking Soda,
<br />Psyllium Husk Fiber), vanilla extract, cream of tartar,
<br />cinnamon.
<br />Manufactured on shared equipment...may contain
<br />[peanuts, tree nuts, wheat, soy, milk
<br />Net WE 302 (85g)
<br />Net weight
<br />307
<br />\
<br />2 of 2
|