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41612-3 <br />Date rint Name Owner's Signa ure <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />7.0U NTY- <br />7. Delivery Limitation: Initial if you agree to abide by the following: VS <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 />Owner's Statement: <br />1, av‘essa Se] <br />conduct an inspection of cottage food operation (mark one) <br />p4 "Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />"Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />1, VasAessat SeJ ai. <br />, agree to notify the San Joaquin County Environmental <br />Health Department prior 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 />, agree to grant access to the local health department to <br />MA. INA HOME KITCHEN <br />P1.11112S PT0025.635 <br />Issued in San Joaquin Gotnty <br />Sits Gisocol*e Chip Cookies <br />Vanessa Saga <br />9351 Cruden Street <br />Stockton, CA S5209 <br />Ingreckents- 0(003(50303 nom niacifl. recitced soh thiamina. monotatrate rilrollauntoko acid). <br />cotter (milk sat). eggs. chocolate chnostsugar. chocolate liquor. milkfat cocoa butter soy lecithin). <br />sugar too., sugar salt taking soda belong ponder oats vanilla bean pa. <br />,ontains lfteat eggs. rialk. soy <br />Net Alt 305 035 050 <br />MAI. 1142 HOME KI80.14 <br />Pam* S 010026408 <br />Issued n San basun Counts <br />Sacker...1e Cookies <br />Varessa Seigel <br />3351 ',Arlen Street <br />Stockton 03 95235 <br />Ingredents Flour(wheat flour niacin reduced ton. timarnine monorail.. nbonann 'oho acid) <br />0041,41 (1,010 sath. eggt sugar haleg soda arnarnot. sauna bean paste <br />Contains Wheat eggs. riklir <br />Net VR 305 (E6 059) <br />2 of 2