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agree to grant access to the focal health Owner's Si^nsfure EMDtwvzaam 6 CFO REGiPERMTHNG FORM “Class A”: In the event of a consumer complaint or reported food-home illness H “Class B": For regular annual facility inspections and in the event of a consumer compteint or food-home /-/8^c DatePrint Name 11. Owner’s Statement: I,Matthew Lewis o._.^ 4..\ department to conduct an inspection of my cottage food operation (mark one) 2. Employee; Initial if you agree to abide by the following:ML I understand that I may not have more than one full-time equivalent cottage food emptoyee. not including a family member or household member of the cottage food operator, working within the registered or permitted area of a private home where the cottage food operator resides and where cottage food products are prepared or packaged for direct, indirect or direct and indirect sale to consumers. IQ.DeliYerY Limitation; Initial if you agree to abide by the following:ML_ I understand that I may accept orders and payments via the internet mail or phone. Direct and Indirect sales may be fulfilled in person, via mail delivery, or using any other third-party delivery service throughout the state of California only. 8_ Fopd Processor Course; Initial if you agree to abide by the following:ML W**3 months of being approved to operate by the Environmental Health Department, please Provide proof of completion of the California Food Handler course in lieu of the CaNfomia Department of Public Health (CDPH) food processor course. For more information see CDPH website WWWxdDhxa^QY/Droararns/PaQes/fdbCottaaeFoQd^soi I--------------Matthew Lewis _ agree to notify the San Joaquin County Environmental Health Department prior to modifying my food list, type of operation, and/or method of selling, distributing, or otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, consigned, or given away.