Le Clementine, LLC in Petersburg

Comments: Visit conducted as a follow up to Hurricane Milton.

Comments: Thank you for submitting your food establishment permit application. To complete the application process, you must remit payment in full. To expedite the processing of your food permit application, electronic online payment is available at https://foodpermit.fdacs.gov. Follow the instructions on the portal page for payment processing. Payment by check or money order is also accepted, but must be made payable to FDACS and remitted to Florida Department of Agriculture and Consumer Services, PO Box 6720, Tallahassee, FL 32314-6720. Please note that payment by check or money order may delay the processing of your food permit application. Permit fees must be paid in full before your application can be processed further. Failure to pay any permit fees in full will result in the denial of your permit and you may be subject to administrative penalties if you are found operating without a valid food permit, which is a violation of Section 500.12(1)(a), Florida Statutes. If you are found to be in violation of this provision, the Department may impose up to a $5,000.00 fine against you and/or seek administrative action to close your business. All requests for a new food permit submitted January 1 through June 30, shall be assessed a permit fee per F.S. Chapter 500 and Rule 5K-4. All requests for a new food permit submitted July 1 through December 31, shall be assessed permit fees of fifty percent (50%) of the applicable fee per F.S. Chapter 500 and Rule 5K-4. The Minimum Requirements stated in 5K-4.033, Limited Poultry and Egg Farm Operation were used by the food safety inspector to determine compliance before farm obtaining a food permit. The farm operation is responsible for meeting all applicable requirements of Chapters 500 and 583, Florida Statutes, Chapters 5K-5 and 5K-6, Florida Administrative Code and USDA Food Safety Inspection Service exemption requirements. ACKNOWLEDGMENT I acknowledge receipt of a copy of this document, and I further acknowledge that I have verified the location and mailing addresses on the first page of this document are correct, or I have written the correct information on the first page of this document. (Signature of FDACS Representative) AMBER RUCKDESCHEL, SANITATION AND SAFETY SPECIALIST (Signature of Representative) PAULINA GRANIELA, OWNER Print Name and Title FDACS 14205 Rev. 07/13 Page 3 of 3 FDACS 14205 Rev. 07/13 Page 1 of 1