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/111 • •/7 <br />-I <br />wner's Signature <br />Lo,pt_h 0,, Oil <br />Print Name 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: k <br />I undeistand 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 hy, and subiect to, CDPH registration and state and federal <br />I t-19U11 11t11 <br />Owner's Statement: <br />i. i.,Lhicia___Cetat_N , agree to grant access to the local health <br />department to conduct an inspection of my cottage food operation (mark one) <br /> <br />K"Class A"; In the event of a consumer Li "Class B": For regular annual facility inspections <br /> <br />complaint or reported food-borne illness and in the event of a consumer complaint or <br />food-borne illness <br />I, 1_,Lt_t_paiLtA_IILL,S.A.ek..Lit_______, agree to notify the San Joaquin County <br />L7.1, azd!:;:. rrzz.,•!.`41;1 <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 />EliG 16-29 6.29120 l5 2 CI-0 RE.GPEHMI II INGIRLNONAI. F OHM