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SA N J O A Q U I N Environmental Health Department <br />—COUNTY <br />7. Delivery Limitation: Initial if you agree to abide by the following: 01 <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 />8. Owner's Statement: <br />I, P I C4 0 1 Ct+ l L M , 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, R 1 04 U VV-\ , 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 />Q © <br />e\ f pO V ✓G rs Ingredients: Flour (unbleached hard red wheat <br />' ` and malted barley) granulated sugar, brown <br />Gourmet sugar, butter, eggs, vanilla, baking soda, salt, <br />`l <br />C��'C C� milk -chocolate chips. <br />V G Contains: eggs, dairy, wheat, may Contain <br />1 Ceokie Enclosed traces of nuts. <br />in(209) 2 9 4-113 7 4 <br />1870 Dove Court.Lodi CA 95240 <br />Made in a Home Kitchen <br />Permit# PT0026298 i%+um�cwmM ss bw <br />EHD 16-29 6/27122 2 CFO REG/PERMITTING RENEWAL FORM <br />