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❑ Nitrite Test (every 3 years`): <br /> "Addininnol InlDmintlon msy hr+mgOlred if fm)d IS prnpnr rid frnm a hrsnn with a rNivafa watar supply-check wffh locai jurisdirtu,n. <br /> S. Food Processor Course: Initial if you agree to abide by the following: <br /> CA <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 Nvebsite v ro a 1Pa 1 x <br /> 9. Employee: <br /> Initial if you agree to abide by the following: _�LeI 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. D ` <br /> Initial if you agree to abide b the following: U <br /> 9 0.Ueli�ery Limitation: Y g y <br /> understand that I may accept orders and payments via the intemet, 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 /> 91. Owner's Statement: <br /> 1 , agree to grant access to the local health <br /> , E�.� `•-�ik��yGi4-f <br /> department to conduct an inspection of my cottage food operation (mark one) <br /> Glass A": In the event of a consumer ❑ "Class B". For regular annual facility <br /> complaint or reported food-borne illness complaint nections a food-borne <br /> in the event of a consumer <br /> 01Vhlf,AtaJ_1'AwAiCTAY <br /> l hd agree to notify the San Joaquin County <br /> l <br /> Health Department prior to modifying my food list, type of operation, andlor method <br /> environmental <br /> of selling, distributing, or otherwise providing my CFO products to the consumer or retailers. <br /> regardless of whether the product is sold, consignees, or' v /w�ay. <br /> iA16,kr <br /> L5//i bay <br /> — C)wner's Signature <br /> -—� — Prinl Name J -- Date <br /> 5 CFO REGPCRMITTIN[,FORM <br /> EHa 1fr27 WM2023 <br />