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Sb N X10 A Q U I N Environmental Health Department <br /> —COUNTY— <br /> 7. Delivery Limitation: Initial if you agree to abide by the following: '� y <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 fS'tate,1ment: <br /> I,- �W i agree to grant access to the local health department to <br /> conduct an inspecn 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, W�I I IV1 agree to notify the San Joaquin County Environmental <br /> Health Departmen prior to modifying my food list, type of operation, and/or method of selling, distributing, or <br /> otherwise providI g my CFO products to the consumer or retailers, regardless of whether the product is sold, <br /> consigned, or n away. <br /> Own ' ignature Print Name Dalf� <br /> Lorina's Edible Garden <br /> Chocolate Walnut Brownies Lorina's Edible Garden <br /> m,aaer+ac.r.nev.�ad Chocolate Walnut Clusters <br /> aoar� .ex++raa�s�^'u.m,m Ingtedients:Walnuts,Chocolate{Sugar.Palm <br /> Kemel and Partially Hydmgemted Pnlm <br /> <a.a.e+�m^m'a aoaac�wr f amraP. <br /> wac�a.� Oils,Whey,Cacoa,Non-Fet Milk,Sorbimn <br /> CWKt ..>et�o a Monostearate and Lecithin Emulsifiers,Pure <br /> SAM,st'���ia Vanilla,and Vauillan(an artificial flavor) <br /> *0i°ea°®`ate CONTAINS NUTS <br /> Imn FDaPtea Eons6" <br /> snJsw:r'a^+•Pi 031 Made in home Kitchen <br /> 17397 Enterprise Road Esmkm Ca 95320 <br /> San Joaquin Permit q PT0024931 <br /> L <br /> Lorinals Edible Garden <br /> Made in Haaoa Sinhea <br /> 1+w.v_.n.r-'-r ltd.Eacalon,^ 957711 <br /> LnnO 4",4gudca-w 2 of 2 <br /> far-Joaquin County lam It FT0=931 <br />