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L__ V <br />SAN 10 A Q U I N Environmental Health Department <br />9. Employee: Initial if you agree to abide by the following: _kl�y_ <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 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 />11. Owner's Statement: <br />I, aA' 0'-' V , 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 ❑ "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-bome <br />I, nW\5oy� c ed� 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 />EMD 15-27 6/29117 <br />V 6\lisoh 1—edoy, ILL <br />ure Print Name Date <br />5 ot5 <br />CFO REG/PERMITTING FORM <br />