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. SANJOAQUIN <br />Environmental Health Department <br />COUNTY <br />Employee: Initial if you agree to abide by the following- ki18 <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 />'Delivery Limitation: Initial if you agree to abide by the following:. LA& <br />:I understand that I may accept orders and payments via the intemet, 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, Feda, 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 />I, iitS0 241.0_,S PlauDdi , agree to grant access to the local health department to; <br />conduct an inspection of my cottage food operation (mark one) <br />"Class A": In the event of a consumer D "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 />LAM__ WAS ii:an)61.1Vei9-_i_. 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 />gelling, distributing, or otherwiee providing my CFO products to the consumer or retailers, regardless of <br />whether the product is sold, consigned, or given away. <br />Lisa Del 03 haarc5iiver - 1/// <br />Owner's Signature Print Name Date <br />5 of 5 <br />EHD 16-27 6/29/17 CFO AEG/PERMITTING FORM