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i <br /> i <br /> ❑ Nitrite Test(every 3 years"): <br /> "Additional information maybe required if food Is prepared from a home with a private water supply—check wild local jurisdiction <br /> 8. Food Processor Course: Initial if you agree to abide by the following: J M <br /> Within 3 months of being approved to operate by the Environmental Health Department, please <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 /> For more information see CDPH websitevvvM.cdpb.cg.aovtproaramstEnces/fdbCotW-qeFoc>d.asPx <br /> 9. EmpioVee: Initial if you agree to abide by the following: � <br /> 1 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: —� M <br /> I understand that [ 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 /> 3 11. Owner's Statement: <br /> 1, Jess k cu M ckc+cL S 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 B": For regular annual facility <br /> complaint or reported food-borne illness inspections and in the event of a consumer <br /> complaint or food-borne <br /> 1, 3e ss icck Ma c►a 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 /> 3e_SS�Cct M0.claS b;L <br /> Owner's Signature Print Name Date <br /> FHD 16.27612912023 5 CFO REGIPERMITTING FORM <br />