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Nitrite Test(every 3 years*): <br /> "Additional information may be required if food is pmperad from a home vAlh it private water supply—check with local Jurisdiction. <br /> 8. Food Processor Course: Initial if you agree to abide by the following: \f `(, <br /> Within 3 months of being approved to operate by the Environmental Health Department, please <br /> provide proof of completion of the California Food Handier course in lieu of the California Department <br /> of Public Health(CDPH)food processor course. <br /> For more information see CDPH website www.rdph.ca.(Iovll)roaramwPanes/fdbCopAgeFogti-aspx <br /> 9. Employee: 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 /> 10.Delivery Limitation: Initial if you agree to abide by the following: V• C <br /> understand that I may accept orders and payments via the intemet, 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 /> 11. Owner's Statement: <br /> I, yoAtnPSc_o c G\ df v O n 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 ❑ "Class S": For regular annual facility <br /> complaint or reported food-bome illness inspections and in the event of a consumer <br /> complaint or food-borne <br /> I, \Ilan C SCh ra1Ar r o r( 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 /> vcky\QsSa• Ccm&c tr n - n - 2.0 2 <br /> Owner's Signature Print Name Date <br /> EHD 16-27 WW2023 5 CFO RMPERMITTING FORME <br />