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ID <br /> 6. Food Processor Course: <br /> Attach food handler certification for owner and each individual that were not submitted with initial <br /> application (including family members and/or employees). <br /> 7. Delivery Limitation: Initial if you agree to abide by the following: yr <br /> I understand that I may accept orders and payments via the internet, mail or phone. However, all "Class <br /> A"and "Class B" CFO products must be delivered directly(in person)to the customer. The CFO products <br /> may not be delivered via the United States Postal Service, UPS, FedEx, or using any other indirect <br /> delivery method as deliveries are regulated by, and subject to, CDPH registration and state and federal <br /> requirements. <br /> 8. Owner's Statement: `� <br /> I, �U( Q9S(\ =2 � , 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 inspections <br /> complaint or reported food-borne illness and in the event of a consumer complaint or <br /> food-borne illness <br /> I, C eQ� ! `s: `(a 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 /> \J- 5 <br /> Owner's Signature Print Name Date t <br /> == WIId E a <br /> ic <br /> m m 9 Y p .q o mu <br /> mm �• n-n 4 • •��-lry, a � a oN o E <br /> Xrn y <br /> " 3 o_� � /�•', ii uc n mew <br /> A V EM E <br /> MTE <br /> e O m> w' �v N (�n ,+ 402 � <br /> c N =2 u n a r 113.40Q e$o E °o <br /> O <br /> OC N sT 00a MILD RUB <br /> M . %Wwuwrvuvnamarearrar <br /> EHD 16-297/27/17 2 CFO REG/PERMITTING RENEWAL FORM <br />