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SAN JOAQUIN Environmental Health Department <br />Delivery Limitation: Initial if you agree to abide by the following: <br />I understand that I may accept orders and payments via the intemet, mail or phone. However, all "Class A" and <br />'Class B" Dfci 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 />I. e_11._.V (c ( \sok kok.,-,,Li - ts-vex- , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br /> <br />0 "Class A": In the event of a consumer RijnClass 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.(PJ—QilinOtLL, , agree to notify the San Joaquin County Environmental Health Department prior to modifyir my ood 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 />CtQ t-t6.1100.cni <br />Owner's Signature <br /> <br />(.3 lout-ruit Ftc3 24) 2_0 7-LI <br />Print Name Date <br /> <br />2 of 2 <br />--vairewsswrar1111111111116111111111111111•11111E