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Environmental Health Department <br />7. Delivery Limitation: <br />8. Owner’s Statement: <br />Date <br />2 of 2 <br />COOKIES <br />3'^- <br /> “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />SAN JOAQUIN <br />COUNTY- <br />SQ “Class A”: In the event of a consumer <br />( complaint or reported food-borne illness <br />Made in a Horne Kitchen <br />Ftrwyf • PTCO25m- Sa" Joaqu-n County <br />1S1 MoktluHuv Rivtr Dr Lodi CA tSHO <br />Ckorolatt Cookit vritk Royal Ring: Cookit Hour (vrMat Rour. <br />moltrd barlru Roar, niarm. nductd iron, thir.rj mononitrate, <br />riMlavin.Mic acid), buttrr (potteurizcd rrtam. fait), cacao <br />powder, iugar, eggc. vanilla, salt Icing: Powdered sugar, com <br />syrup, water, treans of tartar, glycerin, vendla <br />Contains: Lggs. Wheat. Milk. Made in a kitchan that uses nuts <br />i, JuL fyivtehnieK-__, agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />dull Quosfsrsick <br />wsijnanascookiesegrwail.com <br />Mynanascookies-coivx <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. Juh , agree to notify the San Joaquin County Environmental <br />Health Departhrient 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 />* <br />_ Jia.Ii <br />/| Owner’s Signature Print Name <br />Made in a Homa Kitehan: Permit PTOO2S1SS- S*n Joaguin County <br />1S1 Mokatumne River Dr Lodi CA <S24O (201) 1t2-2123 <br />SUGAR COOKIL W/ROYAt ICIWG Ccokil flour (wheat Rcvr. <br />matted barley Rour. niacin, reduced iron, thiamme mononitrate. <br />riMlav-ln. Me acid), butter (pastcuriud cream, salt). Sugar, eggs. <br />vanilla, almond ertract tdna Powdered sugar, com Syrup, <br />manngue powder, water, cream of tartar, glycerin, vamlta <br />Contains fggs. Wlwit. Milk. <br />Made in a kitchen that usas nuti cookie(s)