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SAN.IOAQUIN <br />—k-OL)NTY— <br />Environmental Health Department <br />Delivery Limitation: Initial if you agree to abide by the followin <br />I understand that I may accept orders and payments via the internet, mail or phone. However, I "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 />8. Owner's Statement: <br />I, Chu I (L Z� I( , 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 inspections <br />complaint or reported food -borne illness and in the event of a consumer complaint or <br />food -borne illness <br />I, JU � L J�[4eZ ( , agree to notify the San Joaquin County Environmental <br />Health Department prior to modifying 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 />ELLIOTT ROAD WM <br />if NiN Rusty Rentals B gam k tl s <br />MADE IN A HOME KITCHEN <br />Permit 010027966 <br />Issued in San Joaquin County <br />23216N. Elliott Rd. — <br />Acampo, CA 95226 <br />elliottroadharn®gmail.com <br />WMED BERRY NE <br />MIXED BERRY NE <br />Ingredients: Berries (raspberries, blueberries. strawberries. blackberries) hu <br />Purpose flour (bleached wheat flour, malted barley flour, niacin, reduced iron. <br />asorbic acid, thiamin mononilrate. riboflavin. folic acid, asorbic acid added as a <br />dough conditioner) Sugar. Shortening (soybean oil. fully hydrogenated palm oil. <br />palm oil. mono and diglycerides. 100 and citric acid. natural and artificial flavors. <br />beta carotene) Cornstarch. Butter (pasteurised cream and natural flavoring) <br />Lemon Juice, Egg <br />Contains: wheat, soy. eggs. milk I <br />Net wt. A 4.1oa (1.49kg) <br />2 oft <br />ELLIOTT ROAD BARK <br />Rusty Rentals & Baked Goods <br />MADE IN A HOME KITCHEN 23216 N. Elliott Rd. <br />Permit J/PT0027966 Acampo. CA 95220 <br />Issued in San Joaquin County elliattroadbainNgmail.com <br />LEGION SCONES <br />LEMQM SCQNES <br />Ingredients: MI purpose flour (bleached wheal flour,—malted barley flour, niacin, <br />reduced iron, asorbic acid. thiamin mononilrate. riboflavin, folic acid. asorbic and <br />/ <br />added asadoughcre2m)onowBurneruar(canesugar, and natural flavors) Navy <br />Whipping team (cr¢ani), Powdered Sugar (cane sugar, cornstarch) fresh Lemons. <br />Egg. Pure vanilla. Baking Powder. Salt (salt, calcium silicate, dextrose. potassium <br />iodide) Bating soda (sodium bicarbonate) <br />Contains: wheal, milk, egg <br />Net wt. loo: (283.52) <br />