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SAN _J O A Q U I N Environmental Health Department <br />-COUNTY <br />9. Employee: Initial if you agree to abide by the following: <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, , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />X"Class A": In the event of a consumer <br />complaint or reported food -borne illness <br />❑ "Class B": For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food -borne <br />A0 S _, 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 />IN <br />Patricia Vermilus August 13, 2022 <br />Print Name <br />raNe:r MADE INA HOME KITCHEN <br />7K)OFFY Permit a: 12345 Issued in county: San Joaquin fill�ry <br />FREEZE DRIED GUMMY BEARS =' <br />FreezyFrosty <br />79 N Menlo Park St Mountain Howse CA 95391 <br />FreezyFrosty.com email: freezyfmsty@fastmail.com <br />ingredients: tapioca syrup, cane sugar, gelatin, lemon juice, potato starch, agar, citric <br />acid, sunflower oil, carnauba wax, black carrot juice, purple sweet potato juice, cherry <br />juice, radish juice. <br />Made in a facility where milk, eggs, fish, shellfish, tree nuts, wheat, peanuts, <br />and soybeans are used in the production of other products. <br />Net Wt. z oz. (56.699@) <br />5 of <br />nate <br />