Laserfiche WebLink
SANX10 AQ U IN Environmental Health Department <br /> —COUNTY- <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 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: <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 /> atoyNIo�r u�J agree to grant access to the local health department to <br /> conduinspection of my cottage food operation(mark one) <br /> 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 /> -X1/� I '}1( complaint or food-borne <br /> I. _---1-u`-_ V`r ' O agree to notify the San Joaquin County <br /> Envlronmmmmmml Health Department prior to modifying my food list,type of operation, and/or method of <br /> selling,distributing,or otherwise providing my CFO products to the consumer or retailers,regardless of <br /> whether the product is sold,consigned,or given away. <br /> --VNU : oNuylolzgl�u� <br /> Owner's Signature Print Name Date <br /> 5 of <br /> EHD 1627629/1] CFO REG/PERMFFTING FORM <br />