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Environmental Health Department <br />8. Owner’s Statement: <br />i, <br />Contains wheat Weight. 18.74 oz (520g) <br />0^ <br />2 of 2 <br />IAKED1 <br />BY NYDAM <br />lAKEDi <br />_________BY NYDAM <br />SAN JOAOUIN <br />COUNTY <br />7. Delivery Limitation: Initial if you agree to abide by the following: (gl;----- <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 produc s y <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, UyaW N dlagree to notify the San Joaquin County Environmental <br />Health Department prior tQrnodifying 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 />-r Home Kitchen <br />Rin‘“ - ’’J'”*-'*' in <br />| ^.7'T b S:l ‘Hinr. <br />jN. 4h-2^- hakvdnnynydamugniail.con: John 6:3^ <br />Ife ^lassie <br />Ingredients: organic bread flour (certified <br />lOO-'o organic unbleached hard red wheat <br />four, cenuied 100% organic malted barlex <br />ilouri. organic stone ground white whole" <br />W heat Hour i certified 100" c, organic hard <br />white whole wheat flour), sourdough starter <br />i flour water), water, sea sail <br />Contains: w'heat. Net wr 2 lbs. (900g) <br />/ Mjcie <br />2(Wi 4U-25X" hakedi’.bxTivdani <reniail com John 6.?' <br />Seantough gagelt <br />Ingredients: organic bread Hour (cemfiec 100% <br />organic unbleached hard red wheal four, <br />certified 100% organic mailed barlev flour). <br />1 sourdough starter (organic flour waief). organic <br />diastatic mailed narlex Hour, organic cane sugar ‘ <br />For boiling in water baking soda and organic <br />mated bariex syrup <br />i, fimW M __, agree to grant access to the local health department to <br />conduct an inspection of (jpy cottage food operation (mark one) <br />“Class B”: For regular annual facility inspections <br />-----------. • and in the event of a consumer complaint or <br />< “ClassA^fn the event of a consumer complaint food.borne i||ness <br />~urTeported food-bome illness