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8. Food Processor Course: <br />For more information see CDPH website www.cdph.ca.gov/programs/Pages/fdbCottaqeFood.aspx <br />9. Employee: <br />the product is sold, consigned, or given away. <br />5 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br /> 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 />10. Delivery Limitation: Initial if you agree to abide by the following: <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 />Initial if you agree to abide by the following: XWI <br />Within 3 months of being approved to operate by the Environmental Health Department, please i <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 />Initial if you agree to abide by the following: <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 /> “Class B”: For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-borne <br />Enviroi ital Healtn Depai <br />A {yi (Zm Jo rJ.6Lvi <br />Print Name <br />11. Owner’s Statement: <br />I, ’ a9ree t0 9rant access t0 the local health <br />depa^^t toc^ndWt an inspeclion of my cottage food operation (mark one) <br />l3j)“Class A”: In the event of a consumer <br />' complaint or reported food-borne illness <br />^7 , agree to notify the San Joaquin County <br />lent prior to modifying my food list, type of operation, and/or method <br />of selling, distributi^ig/or otherwise providing my CFO products to the consumer or retailers, <br />regardless of whe' <br />W/ier’s Signature <br />dgIoG /zs <br />Date ' I