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Environmental Health Department <br />7. Delivery Limitation: <br />8. Owner’s Statement: <br />Owner's Sigfiatute <br />2 of 2 <br />□ “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />PermitB PR2aOO372 <br />tasuod in Son <br />Jooqum County <br />Lodi CA 95242 <br />Cookie variety <br />MGneOIENI S M (■•P'iv »oi« vu<»~ <br />•tMn tXXJTf tMMltnQ <br />luud <br />Peanut butter heart <br />INGHtlMNtS <br />tiunm wvw.CnocnUMi t> <**»•- <br />Caramel macaron <br />fNG9fDtfNY$ o*rrKHxjnr>x ttJQOr egg <br />txitlo* rtoovy ctoorncream of <br />tartar. c«»oco«ate wit <br />SANTAQUIN <br />rOU-NTY <br />Print Name <br />rtnkle- 11 <br />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 />I. JiKVfW <br />conoui <br />Net WT 9 17 oz<260g> <br />Contains Egy Nuts Dairy <br />Made in Home Kitchen <br />O “Class A”: In the event of a consumer <br />complaint or reported food-borne illness <br />Sf, <br />Date <br />I, \ \ C7?y fipU " yfharee to notify the San Joaquin County Environmental <br />HealtlvDepartment 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 />V nVA IT) 1U) , agree to grant access to the local health department to <br />ict an inspection of my cottage food operation (mark one)