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SAN10 A O U I N Environmental Health Department <br /> 9. Emolovee: Initial if you agree to abide by the following: C z <br /> I understand[hat 1 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, mall 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 stale and federal requirements <br /> 11. Owner's Statement: <br /> / <br /> I, l _i(, frr 1 ZzlDclfci agree to grant access to the local health department to <br /> conduct an inspection of my cottage food operation(mark one) <br /> U"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 /> I. C lc'rro Z0QL44L1 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 /> -1 � <br /> C,te i i;t aicywLi Gyl / 15 <br /> Owner's§Vature Print Name Date <br /> 5 n1 5 <br /> Ella 1627 GIMI7 CFO REGIPERMITTINO FORM <br />