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SAN1J 0 A QU I N Environmental Health Department <br /> --- COUNTY- - <br /> 7. 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. However, all "Class A" and <br /> "Class B" CFO products must be delivered directly (in person) to the customer. The CFO products may not be <br /> delivered via the United States Postal Service, UPS, FedEx, or using any other indirect delivery method as <br /> deliveries are regulated by, and subject to, CDPH registration and state and federal requirements. <br /> 8. Owner's Statement: <br /> I, N A j\iul W AL.L 10 rZ_'_ agree to grant access to the local health department to <br /> conduct an inspection of my cottage food operation (mark one) <br /> ❑ "Class A": In the event of a consumerA <br /> "Class B": For regular annual facility inspections <br /> complaint or reported food-borne illness and in the event of a consumer complaint or <br /> food-borne illness <br /> I, N AN LJ [A) ALL. ( D O agree to notify the San Joaquin County Environmental <br /> Health Department prior to modifying my food list, type of operation, and/or rnethod of selling, distributing, or <br /> otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br /> consigned, or given away. <br /> A( <br /> YW Mri <br /> s Signature Print Name D e <br /> Made in a Home Kitchen <br /> Permit#: PT0026246 <br /> Issued in San Joaquin County <br /> Shortbread <br /> Nancy Wallior <br /> 539 Brandywine Drive <br /> Lodi, CA 95240 <br /> nan.short.sweet@gmail.com <br /> Ingredients:all-purpose flour(wheat flour, malted barley flour, niacin, <br /> iron,thiamin mononitrate, riboflavin,folic acid), butter, sugar. <br /> No preservatives. <br /> Contains:wheat,butter,sugar <br /> Made to order; baked in small batches. Refrigerate/freeze after 10 days. <br /> Net Wt. approx. oz. <br /> 2of2 <br />