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agree to grant access to the local health <br />inspection of my cottage food operation (mark one) <br />EHD 16-27 6/29/2023 5 CFO REG/PERMITTING FORM <br />“Class A”: In the event of a consumer <br />complaint or reported food-borne illness <br /> Nitrite Test (every 3 years*): ‘ <br />“Additional information may be required If food Is prepared from a home with <br />Print Name <br />xa.qov/proqrams/Paqes/fdbCottaqeFood.aspx <br /> “Class B”: For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-borne <br />a private water supply - check with local jurisdiction. <br />8. Food Processor Course: initial If you agree to abide by the following--V / <br />oi ruoiic rieaitn (CUHH) food processor course. <br />For more information see CDPH website www.cdph. <br />9. Employee: initial if you agree to abide by the following: r- r <br />wh/z^ <br />Date <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. yuCiivCiy <br />11. Owner’s Statement: <br />I. 'A , <br />department to conduct an <br />—7-^—— / . agree to notify the San Joaquin County <br />hLmf DePartment Pri°Lt0 mOdifying my f00d list- tyPe 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 />Owner's Signature