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• N 0 rill NI L, Environmental Health Department <br />-COUNTY" - <br />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 />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 />Delivery Limitation: <br />11. Owner's Statement: <br />t-A-VISt°\ , agree to Orant access to the local health department to <br />conduct an iñspction of my cottage food operation (mark one) <br />"Class A": In the event of a consumer El "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-borne 1 i <br />1i*11151-1k, , 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 />utimai 2/1 /6,(1, <br />s Signature Pri/it Name Date <br />5 of 5