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j i9'r� <br /> ] isP,A v�,j;'� }T <br /> LM1 ylt,�� 3n75ltst�S`.a rteX> �'"Ff.L�` re+fi'S#,�i '' 4�, 5`{++y.,�r+ 'Y � <br /> a ( sr xs5 a` (rkFyYrK � 5. v FFx <br /> 3<i <br /> 'l a4S`A'N �J OA14 N , i t Gia F a 55 '� � ; "tiEnv omental Health,Department <br /> j"r'k5 <br /> J, ,-+eae__ rT ryri va f+;,e• w>t i' ; r f)t - < t f � rk e4 M x;'"e+J��M�r^`, S : i <br /> •x+- uhCn3J ^a.i ,r ' �y y $:Et Ams➢ �t j �. YF (.... - Yfs'` f j'4.°',y...r y, ` s� .. <br /> r.4.?:f'a^,t%aY+ff� <br /> 9 , Emoloyee. � <br /> Initial ,you agree to abide by the following <br /> if <br /> u erstatioi>.r..l May <br /> tli <br /> equivale <br /> > r ? Ifamdy yho uehoo d mbereof the�cottage ffood3operator�rwoiking he"ntllorl permdted rr <br /> r� area of a prorate home where the cottage food operator resldesand where cottage food pnidu 'are�p"repared <br /> padiaged for driectindnec�or'dRed'and indirect sal"to"consumers <br /> 1.*^ + <br /> 10' Delrvery LitniYation. Initial if you agree to abide tijr the follovin,n,.�g" V ' <br /> {ry l ,l <br /> understanC that I maji accept hiders and payments via the mtemet, mad orphone Howeveall Class A'and ' <br /> `Class B CFO products mus[tie delivereiJ'directly in person]to ilia customer:The CFO produc5}may not}be 3 <br /> delivered via the United States Postal Service; UPS;FedEx, or using any other indirect delivery method as ', >- <br /> delrvenes'are regiulated by,and'sub/ect to, CDPH registration and stat"ar'ifetleral' iremen��� <br /> �Updak� 2022 - ablz 61m v:nttin:C2'1` w„� zOR��`r <br /> 11. 'Ownees Statement tet. <br /> . . . .. u <br /> � r <br /> I. lyaJa�rz g a reeto rantaocess"tothe''loialhearthde rtmentto� <br /> 9 a + x <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 faatd t9g d r <br /> complaint or reported food-home fitness f inspections and in the event of a consumer <br /> complaintonfood-home; slttw <br /> yx <br /> I. _LIsse�tt V l� ro <br /> a Pz agree to notify the San Joaquin County <br /> Environmental Health Departinent prior to modifying my food list, type of operation, and/or meth`oil ofi a r R- <br /> setting. distributing.or otherwise providing my CFO products to the consumer or retailers, regardless oft a <br /> whether the product is sold.consigned.or given away. zz <br /> rix"y. <br /> Owner's Signahrre Pint Name Date Sri <br /> Y::rK <br /> . .. >xr '�j !3 ,�.�¢t�{{ ��j�,.y�t tr`�•ax�r2+�u�r k¢. <br /> ' }r':�t'"�� f�'yamlu'yr,3�{�'k` �'Qt• �'� rN>,•r t`t <br /> J.tk.o, CyR'Tti _y "i}. o tl +? > x'„r•�,y`� a <br /> . ''*a�'"`�", .;w ei��` r. 's..Ci,�Si,�•,y,�S-a' 4r' K �K F�. .r. l+.y lw�.. , ..r - <br /> a <br /> - _ ff <br /> - , .�N'+ e(r��' n Hc�'t � �... i�y'Tt ��,fir �'e 4 r.:•` r4-; , <br /> _i :�i YY�`u.t n,�Rry��ly„ �” �c° n r }S yF rY f''.r' �'�'�'t G<f(",T9.• ;ev_v r1 n ,""_.ti" � ; <br /> i ,+;-^,,n: ji'&t�1'si��k��y�'�2,e*�;'">y'w�y a,?4�+�•a�`Zl�� Coss n � i�7 '' , q.,.,; s l�7 ` r.. <br /> 5-ibp,�aF• �'ly""f`iY '-k' <br /> -EMD 16.7r 629117 r qS,, cJ ai „fin fjr 0 -..S r�' r .'fGr-0REGPFAMIrfING FORM �- . <br /> *s 7r Jit . <br />