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Environmental Health Department <br />AowpMIlg fyc\w:o agree to grant access to the local health department to <br />\UwXw i i-weu <br />Print Name <br />3 25 2.(0 <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 />I, Jlit ] T 11/_________ r_------_;. <br />conduct an inspection of my cottage food operation (mark one) <br />{^p'Class A”: In the event of a consumer <br />complaint or reported food-bome illness <br />SAN JOAQUIN <br />countv <br />$8 <br />[• —1 agree to nobly the San Joaquin County Environmental <br />Health Department prior to modifying my food list type of operation and/or method of selling distributing ot <br />Otherwise providing my CFO products to the consumer or irt.i lets irganlless ofwhelhei the product is sold <br />7- Pglivery Limitation initial if you agree to ab.de by the following: j? <br />'?ty aCCeP‘ °rdefS and Pa*ments v,a or Phone However, all ‘Class A‘ and <br />CF° fXoducts musl tx? delivered directly (in person) to the customer The CFO products may not be <br />dehvered via the United Stales Postal Service UPS FedEx, or us^g any other mdired delivery method as <br />deliveries are regulated by. and subject to. CDPH registration and state and federal requirements <br />8. Owner’s Statement: <br />■ .7.. ■ <br />irtment prior to modifying my food list type of operation and/or method of selling distributing <br />consigned or given away <br />it Owner s Signature