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1A6,JU iyo <br />0 ner's Signature <br />'1 -1\1\i/ <br />Print Name <br />T- '2O2 (1C4 <br />Date Date <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: 11/4,7 <br />I understand that I may accept orders and payments via the internet, mail 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 />I, f\ vi k,J A I.- L I c)1-1---. , agree to grant access to the local health <br />department to 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 />N ANc_q LO c->fc' 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 />END 16-29 6/29/2015 2 CFO REG/PERMITTING RENEWAL FORM