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5; (IA. 6v 101 tt/ <br />Print Name al <br />lWi a 1) ai l <br />ate <br />Attach food handler certification for owner and each individual that were not submitted will) <br />11111.1d1 appituativi , <br />(including family members and/or employees). <br />1868 E. HazeIton Avenue I Stockton, California 95205 1 T 209468-34201 F 209 464-0138 1 ww\ttsjcehd.com <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />7. 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 />Owner's Statement: <br />, agree to grant access to the local health department to <br />con ct an inspection of my cottá4e food operation (mark one) <br />0 "Class A": In the event of a consumer <br />complaint or reported food-borne illness I' "Class B": For regular annual facility inspections C <br />and in the event of a consumer complaint or <br />food-borne illness <br />SS VrItl1/2/2-- , agree to notify the San Joaquin County Environmental <br />Health Department prior to modifykg my food list, type of operation, and/or method of selling, distributing, or <br />otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br />consigned, or given away. <br />53 u ut/