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<br />* SAN.;JOAQUIN
<br />COUNTY
<br />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 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 />1, SCfkAocm , agree to grant access to the local health department to
<br />conduct an inspection of my cottage food operation (mark one)
<br />"Class A": In the event of a consumer ,"Class A":
<br />or reported food-borne illness
<br />El "Class B": For regular annual facility inspections
<br />and in the event of a consumer complaint or
<br />food-borne illness
<br />'T.e.,:koko(.2., `,30_>c-Q\-ecN , 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 />L )3O.)j3L -pebbie SacoV
<br />wner's Signature rint Name Date
<br />10A3k-r\eA*--
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<br />Sugar Cookie with Royal Icing
<br />MADE IN A HOME KITCHEN
<br />Debbie's Cakepops and Sweets
<br />1838 Bayberry Lane Tracy, CA 95376
<br />Permit 8 P10029507 Issued In county: San Joaquin
<br />Ingredients: Flour (Bleached Wheat Flour, Niacin, Iron, Thiamine Mononitrate, Riboflavin, Enzymes,
<br />Folic Acid), powder sugar (sugar, corn starch), butter (pasteurized cream [milk], salt), meringue
<br />powder (corn starch, egg whites, sugar, gum arabic, sodium aluminum sulfate, citric acid tartrate,
<br />silica, vanillian), eggs, pure almond extract (water, ethyl alcohol, extractives of bitter almond), baking
<br />powder (corn starch, sodium bicarbonate, sodium aluminum sulfate, monocalcium phosphate), corn
<br />syrup, vanilla extract (water, salt, vanilla extract [water, alcohol, Madagascar bourbon vanilla beans]),
<br />water.
<br />Contains: Wheat, gluten eggs, tree nuts, & dairy Net Wt. 2.39 oz. (67.59g)
<br />Vanilla Cakepops
<br />MADE IN A HOME KITCHEN
<br />Debbie's Cakepops and Sweets
<br />1838 Bayberry Lane Tracy, CA 95376
<br />Permit # PT0029507
<br />Issued In county: San
<br />Ingredients: Enriched Flour Bleached (wheat flour, niacin. iron, thiamin mononitratc, riboflavin, folic acid), Sugar,
<br />Corn Syrup, Leavening (baking soda, sodium aluminum phosphate, monocalcium phosphate). Contains 2% or less
<br />of: Palm Oil, Modified Corn Starch, Corn Starch, Salt, Propylene Glycol Mono and Diesters, Dextrose,
<br />Monoglyeerides, Nonfat Milk, Dicalcium Phosphate, Sodium Stearoyl Lactylate, Xanthan Gum. Cellulose Gum,
<br />Soy Lecithin, Natural and Artificial Flavor. Candy Melts: Sugar, Vegetable oil (palm kernel oil, hydrogenated palm
<br />kernel oil), artificial colors (FD&C Blue 2 Lake, FD&C Yellow 6 Lake, FD&C Red 40 Lake), whey powder, whole
<br />milk solids, titanium dioxide (color), nonfat dry milk solids, soy lecithin (an emulsifier) salt, artificial flavor.
<br />Contains: WHEAT, EGG, MILK, AND SOY Net Wt. 1.67 oz. (38.7R)
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