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SAN JOAQUIN <br /> <br />Environmental Health Department <br />----COUNTY-- <br />Delivery Limitation: Initial if you agree to abide by the following: <br />I understand that I may accept orders and payments via the Internet, mail or phone. However, al "Class A" 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 />Owner's Statement: <br />1,\JVCCk-C, e , agree to grant access to the local health department to <br />conduct an inspection of my cottdge food operation (mark one) <br /> <br />El4lass A": In the event of a consumer "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, if.: %-1 ;\•,' , agree to notify the San Joaquin County Environmental <br />Health Department prior to modiyn6 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 />Citt „ (k-A,CA <br />Owner's Signature <br /> <br />kjon OficcYikAa_v'ekel 2_712_0 r7_-(-I <br />Print Name Da e <br /> <br />2 of 2