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Fr r»o*'r:«n‘aI MaarthSANJOAOUIN <br />yvudt^i^o^ <br />Print Name <br />aWc im a how»e kitckz.w <br />loz 2fe <br />Owner's Signature <br />I <br />fycry^ViiM^ frrcz.e i2nrJ LLC <br />I Ca MhZAZ <br />I '. *»r,d IM ' U4M . jArtdMIM Co <br />irnrrt 112 00Z^433 <br />Evenf+Viin^ frccve Pried LLC <br />Lodi 45242 <br />Issued in San Jod^uivt Co <br />lervnit IP 0024433 <br />Salt vM^ter Taffy <br />iw^rediewts; corn s^rup, su^ar, vegetable oil, malic <br />acid, sodium ci-trate, whites, salt, artificial <br />flavors A colors, <br />Made in a home kitchen <br />Made with care, not mass produced <br />2 nt. 5g> cjrams <br />Date <br />Q “Class A": In the event of a consumer <br />'' complaint or reported food borne illness <br />8. Owner’s Statement: <br />I ~ __________________ agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />Nuk’b^ ytlfis <br />■»Myc4«cw+\..Cor»t SsrMi-, Su<y»r, Ucxt-ro-x;, t«^ <br />Starcn, vtotfx. Z^o or 1 (>'■'■ oi /Vui), <br />fj+rv. -Vui. 'xxkMW atr^tc, Ai-P* luiie CMtcartTAtc, Natural aotti <br />Artirkual f U»vor'„ 6fMWi Arabic, Camauioa Wax, Color AtidcA. PrJ 40, <br />/dlow 5, Pzd 40 late, /rJlow b I akc, Z 1 Velio* (p. <br />CjAor. ^lae 1, Vlue 1 I ake, watenneloM . Joice Qxewtratc. <br />□ “Class B”: For regular annual facilrty inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />yV/^ <br />•j QehvTY Limitation: Initial if you agree to abide by the following--------------- <br />I understand that I may accept orders and payments va the internet ma<i or phone Howe/er a’-' C ass A aM <br />•Class B' CFO products must be delivered directly (m person) to the customer The CFO p'-oducts may no? be <br />oeive^ed via the United States Postal Service UPS FedEx o* using any other mdrect dei>ve*y rr^/xl as <br />oekvenes are regulated by and subject to CDPH registration and state and federal requirements <br />I y VTz^y agree to notify the San Joaquin County Environmental <br />Health Department pnor to modifying my food list type of operation, and/or method of selling. d«tr^ut,n^°r <br />otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sera <br />consigned, or given away.