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SANJ O A Q U I N Environmental Health Department
<br /> ---COUNTY
<br /> 7. Delivery Limitation: Initial if you agree to abide by the following: 4"Cs
<br /> I understand that I may accept orders and payments via the internet, mail or phone. However, 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 /> a � � u�shn kCK
<br /> I, , 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 El "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, J U i k\lUkS INV) 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 /> r
<br /> wner's Signature Print Atarne Date
<br /> I
<br /> My Nana's Cookies - -- -
<br /> 20q) 482-2923 .lull Quasknlck
<br /> mynah ascookies.com
<br /> Instagram/ Facebook (209) 482-2923
<br /> Made in a Home Kitchen vnynanascookies@gVnail.coVv�
<br /> Permit# Instarave/Facebook: PT0025956-San Joaquin County 9
<br /> 151 Mokelumne River Drive,Lodi CA g524o Made in a Howe Kitchen
<br /> Chocolate Chip Cookie Permit#: PT0025gs6
<br /> Ingredients:Oats,Flour(wheat flour,malted barley 5an Joaquin County
<br /> flour,niacin,reduced iron,thiamine mono-nitrate, 151 Mokelumne River Drive
<br /> riboflavin,folic acid),butter,chocolate chips,sugar, Lodi,CA 85240
<br /> eggs,vanilla,baking soda,baking powder,salt. Pecan Shortbread Cookie Ingredients: Flour
<br /> Contains: Wheat,eggs, (wheat flour,malted barley flour,niacin,reduced
<br /> iron,thiamine mononitrate,ribo%avin,folic acid),
<br /> (Made in a kitchen that uses nuts.) butter(pasteurized cream,salt),sugar,pecans,
<br /> vanilla
<br /> Contains: Wheat,nuts,milk
<br /> (Made in a kitchen that uses nuts)
<br /> 2of2
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