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SA N$J O A QU I N Environmental Health Department <br /> .--COUNTY- <br /> 9. <br /> COUNTY- <br /> 9. Employee: Initial if you agree to abide by the following: LG <br /> I understand that I may not have more than one full-time equivalent cottage food employee, not including a <br /> family member or household member of the cottage food operator, working within the registered or permitted <br /> area of a private home where the cottage food operator resides and where cottage food products are prepared <br /> or packaged for direct, indirect, or direct and indirect sale to consumers. <br /> 10. Delivery Limitation: Initial if you agree to abide by the following: LG <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 /> 11. Owner's Statement: <br /> Luciano I. Gomes agree to grant access to the local health department to <br /> conduct an inspection of my cottage food operation (mark one) <br /> [l"Class A": In the event of a consumer ❑ "Class B": For regular annual facility <br /> complaint or reported food-borne illness inspections and in the event of a consumer <br /> complaint or food-borne <br /> Luciano I. Gomes agree to notify the San Joaquin County <br /> Environ ntal Health Department prior to modifying my food list, type of operation, and/or method of <br /> selling, tributing, or otherwise providing my CFO products to the consumer or retailers, regardless of <br /> wheth the produ 2s sold, consigned, or given away. <br /> i <br /> iano I. Gomes 02/20/2020 <br /> Owner ignature Print Name Date <br /> 5of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />