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8. Food Processor Course:in; <br />9. Employee: <br />10.Delivery Limitation: <br />Dateignature <br />5EHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br /> Nitrite Test (every 3 years*): <br />“Additional information may be required if food is prepared from a home with a private water supply - check with local jurisdiction. <br />Initial if you agree to abide by the follox <br />Within 3 months of being approved to operate by the Environmental Health Department, <br />provide proof of completion of the California Food Handler course in lieu of the California I <br />of Public Health (CDPH) food processor course. <br />S] “Class A”: In the event of a consumer <br />complaint or reported food-borne illness <br /> “Class B”: For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-borne <br />i. HtSfctW VUo&me/ <br />Environmental <br />of selli <br />Print Name <br />For more information see CDPH website www.cdph.ca.qov/proqrams/Paqes/fdbCottaqeFood.aspx <br />11. Owner’s Statement: <br />i, _____, agree to grant access to the local health <br />department to conduct an inspection of my cottage food operation (mark one) <br />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 abd <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 />tfease <br />[eoartment <br />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 witnityfhe <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 />, agree to notify the San Joaquin County <br />ilth Department prior to modifying my food list, type of operation, and/or method <br />-rcfistributing^or otherwise providing my CFO products to the consumer or retailers, <br />5S of whether the product is sold, consigned, or given away.