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Environmental Health Department <br />7. Delivery Limitation: <br />8. Owner’s Statement: <br />2 of 2 <br />□ “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-bome illness <br />^4 <br />Date <br />SAN JOAQUIN <br />COUNTY <br />Print Name <br />£^“Class A”: In the event of a consumer <br />complaint or reported food-bome illness <br />, agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />Once Upon A Cookie <br />Stockton, CA 95219 <br />Permit #FA0001341 Issued in San Joaquin County <br />VANILLA BEAN SUGAR COOKIE INGREDIENTS <br />Enriched flour (wheat flour, niacin, reduced Iron, thiamine, mononitrate, <br />riboflavin, and folic acid), butter (milk, sail), sugar, eggs, vanilla bean <br />paste, baking powder, salt. <br />ROYAL ICING INGREDIENTS <br />Powder sugar, meringue powder, salt, vanilla extract, water, food <br />coloring. <br />MADE IN AIIOME KITCHEN. NOT A NUT FREE KITCHEN <br />Initial if you agree to abide by the following: \fC> <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. I 11 AS , 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.u <br />Owner's Signature