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SA N J O A Q U I N Environmental Health Department <br /> (- 0UNTY--- <br /> 7. 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 /> 8. Owner's Statement: <br /> I, 19 1 C10- i Q UM 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, I d Q Qt um 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 /> 4�9Q <br /> Owner's Signature Print Name Date <br /> rr\r DOU5'S <br /> Gourmet (209) 294-1374 <br /> C'v K'ES Lodi CA 95240 <br /> 1 Cookie Enclosed Made in a Home Kitchen <br /> 1870 Dove Court.Lodi,CA 95240 <br /> Permit#PT0026298 Issued in County:San Joaquin <br /> Ingredients:Flour(unbleached hard red wheat <br /> and malted barley)granulated sugar, brown <br /> sugar,un-salted butter,chips(sugar,chocolate, <br /> cocoa butter,nonfat milk,soy,lecithin, natural <br /> flavor)eggs,vanilla,baking soda, salt, <br /> Contains:eggs,dairy,wheat,soy,may contain <br /> traces of nuts. <br /> 2of2 <br />