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UUma_ <br />Print Name Date <br />CFO REG/PERMITTING FORM <br />5 <br />EHD 16-27 6/29/2023 <br />J <br />8 Fond Proctor C»ur«« initial If you agree to abide bythefollowlng: <br />of Public Health (CDPH) food processor course. <br />For more Information see CDPH website <br />tn naiiven, Limitation: »»»“ ~~“ "» **’*>*• <br />service throughout the state of California only. <br />□ “Class B”: For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-borne <br />[71 “Class A”: In the event of a consumer <br />™ complaint or reported food-borne illness <br />Q f mnlnvnp- lnitial if y°U a0ree tO ab'de tbe f°ll0W'ng: — <br />■ , understand that! may not have more <br />including a family member or household ^mbe of m t J f tor resides and where <br />indU or dX and Indirect saie to <br />consumers. <br />of sellina distributing, or otherwise providing my CFO productsi o vie o <br />regardless of whether the product is sold, consigned, or gtven away. <br />_ -'"I • <br />Ovi/Her’s Signature <br />SZ'X— a private wa,arSuS^*l0ea.M>S*ton.