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Environmental Health Department <br /> jar’s Stato^ont:2. £>■ <br />Date <br />\J oK'iA. V Wd <br />2q<: <br />_________________, agree to grant access to the local health department to <br />icottage food operation (mark one) <br />fj •■Cinsjt tr1: t-or regular annum facility inspections <br />and in the event of a consumer complaint or <br />food-bome illness <br />SAN JOAQUIN <br />COUNTY <br />IAKEI <br />________BY NYDAM lAKEDi <br />_________BY NYDAM <br />HYY\W <br />Print Name <br />fc "Class A": in the event pt 0 consumer <br />' complaint or reported food-bome illness <br />Ingredients organic flouricertified 100% <br />organic unbleached hard red wheat flour, <br />certified 10(1% organic malted barlcv <br />flour), organic extra virgin olive oil’ <br />organic garlic powder, sea sal: <br />Contains: wheat. Net wt. ] lb. 13 oz. (828g) <br />Madr In Hume Klichen <br />JXy AW <br />k kJ-7•* <br />201n'4u-2.'X* ■ bdkedir-'Vtivdam a gmail corn John 6;3S <br />QwwlMglt <br />Ingredient', organic bread tlour icertified 100",. <br />vrganx uhblcaehcxl hard red wheat flour certified <br />IttO".. organn malted bancc llour) organic Slone <br />gn-and while whine wheat llout itcriilied 100", <br />organic hard w hite whole wheal liuurl sourdough <br />starter ( Hour water), wa-ci. sea sail <br />Contains: wheat. Net wt: 1,7 lbs. (760) <br />i. Vi w <br />conduct an inspection of nijdcottac. <br />7 Delivery Limitation: Initial if you agree to abide by the followin^F^ys — <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 />1.V\Vr\Vw V Ad cVy/C)_____ narp»> In nntify Ihp San .Inaniiin Cnunly Fnvirnnmpntal <br />Hcalth^DepStmentpi^ to modifyingniyfood list typo of operation, and/or method of selling, distributing, or <br />otherwise providing my CFO products to the consumer or retailers, regardless of whether trie product is sold, <br />consigned, or given away. <br />Owner's Signatured <br />Made In Horne Kitchen <br />Rw FACHl. l'li><IM;iM <br />, Issued bj Sou Joaquin C ounr>............................ . <br />-(i^lo^'r baked-thyii^Kin a;gmaii.com John 6:35/te3awtywffouglt <br />-exp - 2^ - 2^ ,