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SAN JOAQUIN Environmental Health Department
<br />COUNTY--
<br />7. Owner's Statement:
<br />iN,1 agree to grant access to the local heatth department to g
<br />conduct an insp ction of my cottage food operation (mark one)
<br />
<br />El "Class A": In the event of a consumer "Class B": For regular annual facility inspections
<br />
<br />complaint or reported food-borne illness nd in the event of a consumer complaint or
<br />food-borne illness
<br />
<br />Qi ,C,A1 te, S , agree to notify the San Joaquin County Environmental
<br />Health Department p or 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 />aLoL s
<br />Date
<br />Ar1,12
<br />ner's Signature Print Name
<br />Sweets & Dough Artisan-Bakery
<br />Mini Rosemary Garlic Focaccia
<br />Made In A Home Kitchen
<br />/ San Joaquin CO CFO Class B Permit #2906
<br />Ripon California 95366
<br />209-481-7555
<br />Ingredients: Organic flour (vitamin c, niacin, reduced iron, thiamine,
<br />riboflavin, folic acid) filtered water, natural levain, garlic infused
<br />olive oil, home grown organic rosemary.
<br />Contains: Wheat
<br />Net wt. 1.16Ibs (527g.)
<br />Sweets & Dough Artisan Bakery
<br />Cinnamon Raisin Sourdough Bread
<br />Made In A Home Kitchen
<br />San Joaquin CO CFO Class B Permit #2906
<br />19818 N Ripon Road, Ripon California 95366
<br />209-481-7555
<br />Ingredients: Organic flour (vitamin c, niacin, reduced iron, thiamine,
<br />riboflavin, folk acid) filtered water, natural pre-fermented leaven,
<br />organic raisins, organic cinnamon, organic sugar, salt.
<br />Contains: Wheat.
<br />Net wt. 1.82Ibs (934g.)
<br />Sweets & Dough Artisan Bakery
<br />Brown Butter Sourdough Chocolate Chip Cookie
<br />San Joaquin CFO Class B Permit #2906
<br />Ripon California 95366
<br />209-481-7555
<br />Ingredients: organic wheat flour (vitamin C, niacin, reduced iron, thiamine,
<br />riboflavin, folic acid) dark chocolate, butter, egg, natural levain,
<br />brown sugar, granulated sugar, baking powder, baking, soda, vanilla salt
<br />Contains: Wheat, Eggs, Dairy, Soy
<br />Net wt. varies
<br />EHD 16-29 6/27/22 2 CFO REG/PERMI1T1NG RENEWAL FORM
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