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4 <br />Environmental Health Department <br />agree to grant access to the local health department to <br />2 of 2 <br />SAN JOAQUIN <br />COUNTY <br />g/em/toas <br />Print Name <br />□ “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />.-----------------------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 /> Owner's Signature <br />i. dm CaM , : L _ <br />conduct an inspection of my cottage food operation (mark one) <br />K|j‘Class A”: In the event of a consumer <br />f complaint or reported food-borne illness <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 />C ass 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 />8. Owner's Statement: <br />Date