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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Delivery Limitation: <br />jA t <br />Initial if you agree to abide by the following: ( \ <br /> <br />I understand that I may accept orders and payments via the Internet, mail or phone. Direct and Indirect sales <br />may be made in person, via mail delivery, or using any other third-party delivery service throughout the state <br />of California only. <br />Owner's Statement: <br />‘YY1\9ef tut \AO\(tAJAI , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />1740 lass 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, V) nbef VADOWJP , 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 />\h 019- ef LUI WI.U1 /4 )-el ) ID'C l <br />Owner's Signature Print Name Date <br />2 of 2