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8. Food Processor Course: <br />9. Employee: <br />EMC 1&-27 &29-2023 5 CFO SEG^PERMrrrHG FCRM <br />2] Nitrile Test (every 3 years*). <br />“Ad(llUCA’<l kHroTnalicn r.*y no icqurad If food h prepofed Mm e> fcnw wlh 4 pkato water sipply’ - check vxth loco lUTadhtion <br />® ‘'Class A”: in the event of a consumer <br />complaint or reported food-borne Alness <br /> uClass B": For regular annual facility <br />inspections and in the event of a consumer <br />camplaint or food-borne <br />MOW <br />Pnnt /Yam© Pare 1 <br />Initial if you agree to abide by the following: V \ <br />Within 3 months of being approved to operate by the Environmental Health Department, please <br />provide proof of completion of lhe California Food Handier course in lieu of the California Department <br />ot Public Hearth (CDPH) food processor course <br />For more information $**a COPI I wxrw-cdoti.gg.gOT-'cfOOfflms/PiXi^MbCottflqehpQCl.&spx <br />Initial if you agree to abide by the following: U J <br />I understand that I may not have more than one full-time equivalent cottage food employee, not <br />incfodlng a family mentboror household member of the cottage food operator, working within the <br />registered oi 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 />10. Delivery Limitation: Initial if you agree to abide by the following: U V \l <br />I understand that I may accept orders and payments via the Internet, mail or phono. Direct arid <br />Indirect sales may be fulfilled in peison. via mail delivery, ur using any other third-party delivery <br />service throughout the stale of California only <br />WwtA.. agree to notify the San Joaquin County <br />Environmental Health Department prior to modifying my food fist, 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 lhe product is sold consigned, or given away <br />Owner’s ^gn&fure <br />11. Owner’s Statement: ~ <br />I■ Ijly\A . agree to grant access to the focal health <br />department to csiductan inspection of my cottage rood operation (mark one)