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Environmental Health Department <br />2 of 2 <br />Q “Class A’’: In the event of a consumer <br />complaint or reported food-bome illness <br />SAN JOAQUIN <br />COUNTY— <br />Print Name / <br />i. <br />Health Department prior to modifying my food list, type of operation, and/or method of selling, distributinq <br />otherwise providing my CFO prodi ---------------------------- ---------------------- <br />consigned, or given away. <br />ier’s Signature <br />agree to notify the San Joaquin County Environmental <br />to the consumer or retailers, regardless of whether the product is sold, <br />M/1 <br />Oi <br />A / <br />Sourdough Cinnamon Roll <br />Made In A Home Kitchen / <br />Permit #PT0028468 z <br />Issued in San Joaquin County ' <br />Joe Kelley <br />894 Golden Pond Dr, Manteca, CA 95336 <br />kelleyii@aol.comIngredients: Bread Flour (Unbleached hard red <br />wheat flour, Malted barley flour) Butter, Whole Milk. <br />Brown Sugar. Powdered Sugar. Cinnamon, Egg, <br />Water. Yeast, Salt <br />Net Wt 21b (9074g) / <br />7- nejjyery Limitation: initial if you agree to abide by the following: <br />accePt^rs and payments via the internet, mail or phone. However,. all/la^A" and <br />C ass B CFO products must be delivered directly (in person) to the customer. The CFO produpfcmay not be <br />de ivered via the United States Postal Service, UPS, FedEx, or using any other indirect delivery method as <br />deliveries are regulated by, and subject to, CDPH registration and state and federal requirements. <br />8. Owner’s Statement: <br />--------------- —■ agree to grant access to the local health department to <br />conduct an inspection of my cotfage food operation (mark one) <br />My Class B”: For regular annual facility inspections <br />T^and in the event of a consumer complaint or <br />food-borne illness <br />J / <br />f?'' i/-|- kvY s <br />Rye Sourdough / <br />Made In A Home Kitchen / <br />Permit #PT0028468 ' y <br />Issued in San Joaquin County <br />Joe Kelley <br />894 Golden Pond Dr, Manteca, CA 95336 <br />kelleyii@aol.com <br />Ingredients: Bread Flour (Unbleached hard red •< <br />wheat flour, Malted barley flour) Barley Malt Syrup. ' <br />Whole Grain Rye Flour. Water, Yeast Salt <br />Net Wt 2lbs (970g) z