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Environmental Health Department <br />8. Owner’s Statement: <br />. agree to grant access to the local health department to <br />2 of 2 <br />Print Name <br />1/-ZI- Zd>Z^ <br />Date <br />Q ‘‘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-bome illness <br />SAN JOAQUIN <br />- COU NTY-- <br />Own^ris^gnature <br />° ■ a9ree ,0 notifyltie 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 />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 />I, ^5 rA-lc^Q V.vn o S________ <br />conduct an inspection of my cottage food operation (mark one)