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griArA <br />wner's Signature Print Name <br />Food Processor Course: <br />Attach food handler certification for owner and each Individual that were not submitted with initial <br />application (including family members and/or employees). <br />Delivery Limitation: Initial if you agree to abide by the following: <br />I understand that I may accept orders and payments via the Internet, mall or phone. However, all "Class <br />A" and "Class B" CFO products must be delivered directly (in person) to the customer. The CFO products <br />may not be delivered via the United States Postal Service, UPS, FedEx, or using any other indirect <br />delivery method as deliveries are regulated by, and subject to, CDPH registration and state and federal <br />requirements. <br />Owner's Statement: <br />V-V(Alltt, , agree to grant access to the local health <br />department to conduct an inspection of my cottage food operation (mark one) <br />D: "Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />0 "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />%((‘ , agree to notify the San Joaquin County <br />Environmental Health Department prior to modifying my food list, type of operation, and/or method <br />of selling, distributing, or otherwise providing my CFO products to the consumer or retailers, <br />regardless of whether the product is sold, consigned, or given away. <br />Date <br />Sugar Cookie feign-divots: <br />Enriched flour (wheal 11 00000 malted barley floor <br />niacin, iron, riIo,II.i iii 0000000000 titrate, fulii acid <br />hut in (cream, salt), gt atuilatell and sugar, eggs <br />imitation al I V% I I act ( ticohol, artificial fla% ors) <br /> <br />C(/NT.XI k, I. I :1 NVIII•AT, 11,111.1i <br />:s4 I. I NN I .sot (sag) <br />EHD 16-29 6/29/2015 <br /> 2 CFO REG/PERMITTING RENEWAL FORM <br /> <br />1