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I <br /> I <br />'rint Na. <br />5 CFO RtGPLKMlI I IMG FORMEHD 16 27 6/29^2023 <br />I <br />Dale <br />"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 Nitrite lest (every 3 years*) <br />•■AcWitionnl informatton may !>• rrqulrrd ll food is po|»rod from a Ikmtio with fl private water stfiply cher k z/rth local junsrjir tion <br />10. Delivery Limitation: 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 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 />j agree to grant access to the local health <br />department to conduct aninspection of my cottage food operation (mark one) <br />8. Food Processor Course: Initial if you agree to abide by the following: bS2 <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 />fo/ more information see corn website www-cdph ca.pQv/nfngrams/Pane*Vf(1hCottapef ood flsnx <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 />< I (A1 j iJJU , agree to notify the San Joaquin County <br />Environmental HealthDdpartment 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.