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. I <br />Environmental Health Department <br />8. Owner’s Statement <br />2 of 2 <br />VS CUSTOM CONFECTIONS <br />8351 Cruden St. Stockton, CA 95209 <br />MADE IN A HOME KITCHEN <br />Permit 0PTOO264O8 <br />NelWt 75g <br />Contains. Wheat, eggs, soy. and dairy <br />NOT PRODUCED IN A NUT FREE KITCHEN <br />VS CUSTOM CONFECTIONS <br />8351 Cruden St. Stockton, CA 95209 <br />MADE IN A HOME KITCHEN <br />Permit #PT0026408 <br />NetWt 60g <br />Contains: Wheat eggs, and dairy <br />NOT PRODUCED IN A NUT FREE KITCHEN <br />SANJOAOUIN <br />-COUNTY- <br />SALTED CHOCOLATE CHIP COOKIES <br />Ingredients: Flour butter, dark brown sugar sugar <br />eggs oats vanilla bean paste chocolate chips, baking <br />powder baking soda sea salt <br />BROWNIE BARS <br />Ingredients: Flour, butter, sugar, <br />eggs vanilla bean paste, cocoa powder <br />/ Print Name <br />7. 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 />deliveries are regulated by. and subject to, CDPH registration and state and federal requirements. <br />Date <br />□ “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />\ j SpA Q • a9ree t0 notify the San Joaquin County Environmental <br />Healtt^Dopartment phor tojZodifying 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 /> <br />Owners S/gni <br />\ I y _______agree to grant access to the local health department to <br />co^u^ an inspection of my Jottage food operation (mark one) <br />Class A”: In the event of a consumer <br />’ complaint or reported food-borne illness