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❑Nitrite Test(every 3 years'): <br /> "Additional information may bo required if food is prepared from a home with a private water supply-check Wth local iurisdiclion_ <br /> S. Food Processor Course. Initial if you agree to abide by the following: <br /> Within 3 months of being approved to operate by the Environmental Health Department,please <br /> provide proof of completion of the Catrfornla Food Handler course in lieu of the California Department <br /> of Public Health(CDPH)food processor course. <br /> For more information see CDPH website www.cdoh.ca.aovioroarams/PaacVfdi>CottaaeFood.asoK <br /> 9. Employee: 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 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 /> 1O.Pelivery Limitation: Initial If you agree to abide by the following: <br /> 1 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. <br /> 11. Owner's Statement: <br /> I, j,Q ii ,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 /> �/ n (�1y(� , ' complaint or food-borne <br /> C`"C 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 /> Owner's Signature Print Name Date <br /> EHD 1627 U2912023 5 CFO REGMERMITTING FORM <br />