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SAN:=J O A Q U I N Environmental Health Department
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<br /> 7. DeliverV Limitation: 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 /> 8. Owner's Statement:
<br /> 1, %�X A agree to grant access to the local health department to
<br /> conduct n inspec ion of my cotta food operation (mark one)
<br /> "Class A": In the event of a consumer ❑ "Class B": For regular annual facility inspections
<br /> complaint or reported food-borne illness and in the event of a consumer complaint or
<br /> food-borne illness
<br /> 1, agree to notify the San Joaquin County Environmental
<br /> Health Department prior toYhodffying 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 /> \_, A nA)— V ,,,
<br /> Owne v ignature Print Name Date
<br /> MADE IN A HOME KITCHEN
<br /> PERMIT# PT0023514
<br /> San Joaquin County
<br /> Chocolate Cupcakes w/Buttercream Icing
<br /> Kim Duke
<br /> 1991 E.Pettier Rd.
<br /> Acampo,Ca 95220
<br /> Ingredients Enriched flour(Wheat Flour,niacin,reduced iron,
<br /> thiamine mononitrate,riboflavin and folic acid),buttermilk,butter(milk,
<br /> salt),cocoa powder, sugar,eggs,salt,vanilla extract,baking powder,
<br /> baking soda,coffee. Icing.Powdered Sugar,butter,milk&vanilla
<br /> extract
<br /> Contains: Wheat,eggs,milk,soy,
<br /> Net Wt.ISoz.per dozen
<br /> J
<br /> MADE IN A HOME KITCHEN
<br /> PERM IT#PT0023514
<br /> San Joaquin County
<br /> Peanut Butter Cookies
<br /> Tim Duke
<br /> Ingredients: Enriched Flour(Wheat Flour,niacin,reduced iron,thiamine
<br /> mononitrate,riboflavin and folic acid),butter(Milk,salt),peanut butter,
<br /> granulated sugar,brow sugar,eggs,pure vanilla
<br /> Contains:Wheat and milk products,peanuts
<br /> Net Wt 1 oz.per cookie
<br /> 2of2
<br />
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