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SKJ0 A 0 U IN Environmental Health Department <br /> COUNTY- <br /> 9. <br /> OUNTY9. Employee: Initial if you agree to abide by the followings* <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 direct) (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 /> I, C4kfJ_CT/!_IE N ipo agree to grant access to the local health department to <br /> conduct an inspection of my cottage food operation (mark one) <br /> cClass A": In the event of a consumer ❑ "Class B": For regular annual facility <br /> omplaint or reported food-borne illness Inspections and in the event of a consumer <br /> complaint or food-borne <br /> 1, C44-Q-tsi!L4z� agree to notify the San Joaquin County <br /> Environmental 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 /> allil�— C`N21Si�i L� t,IiES �Kr�ls) Ilei <br /> Owner's Signature Print Name Date <br /> 5 of <br /> EHO i6-276/29/17 CFO REG/PERMITTING FORM <br />