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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HAM
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1600 - Food Program
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PR0549015
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
9/13/2024 2:45:54 PM
Creation date
9/13/2024 2:45:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0549015
PE
1608
FACILITY_ID
FA0028124
FACILITY_NAME
DEFIANT BAKING COMPANY
STREET_NUMBER
500
Direction
N
STREET_NAME
HAM
STREET_TYPE
LN
City
LODI
Zip
95242
CURRENT_STATUS
01
SITE_LOCATION
500 N HAM LN
P_LOCATION
02
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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El 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: .1\ Initial if you agree to abide by the following: 1 <br /> <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.qov/programs/Pacies/fdbCottacieFood.aspx <br />Employee: Initial if you agree to abide by the following: -) <br /> <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: <br />) \\J <br />Initial if you agree to abide by the following: <br /> <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 />I, \c , agree 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 111] "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.le c0/ t•iv\AA.. , 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 />Owner's Signature Print Name Date <br />EHD 16-27 6/29/2023 5 CFO REG/PERMITTING FORM
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