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SANjOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY <br />7. Delivery Limitation: Initial if you agree to abide by the following: al— <br />I understand that I may accept orders and payments via the internet, mail or phone. However, all "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 />ra-td(x. I u ry\ ,agree to grant access to the local health department to <br /> <br />conduct an inspection of my cottage food operation (mark one) <br />X"Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />"Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />R I 6,0L. ed-urn , 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 />ici4cCTE4u 9 -a4 <br />Owner's Signature Print Name Date <br />Ingredients: Flour (unbleached hard red wheat <br />and malted barley) granulated sugar, brown <br />sugar, un-salted butter. chips (sugar, chocolate, <br />cocoa butter, nonfat milk, soy, lecithin, natural <br />flavor) eggs, vanilla, baking soda, salt, <br />Contains: eggs, dairy, wheat, soy, may contain <br />traces of nuts. <br />ri\T DOU9's <br />Gourmet <br />COOKIE5 <br />1 Cookie Enclosed <br />(209) 294-1874 <br />Lodi CA 95240 <br />Made in a Horne Kitchen <br />1670 Dove Court, LOdi, CA 9570 <br />Permit# P10026298 Issued in County: San Joaqum <br />2 of 2