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s/Paqes/fdbCottaqeFoo<|.q?PX <br />Owner’s Signature <br />5 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />[aii] <br />□ “Class B”: For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-borne <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 />Date <br />£|i^r <br />Print Name <br />11. Owner’s Statement <br />I *<r- 5^^1C«. <br />department to conduct an <br />agree to grant access to the local health <br />inspection of my cottage food operation (mark one) <br />gC'Class A”: In the event of a consumer <br />complaint or reported food-borne illness <br />8. 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 California 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.cdph.ga.qov/proq <br />\ Al <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 />in Delivery Limitation: Initial if you agree to abide by the following: XJ----- <br />I 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 />'"’Ce I ( agree to notify the San Joaquin County <br />Fr^im^ntal Health artment prior to modifying my food list, type of operation, and/or method <br />of sellino^istributing or otherwise providing my CFO products to the consumer or retailers, <br />regafSessdf whether the product is sold, consigned, or given away.