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SA N'J 0 A QU I N Environmental Health Department <br /> COUNTY <br /> 9. Employee: Initial if you agree to abide by the following: �K M <br /> I understand that I may not have more than one full-time equivalent cottage food employee, not including a <br /> family member or household member of the cottage food operator, working within the registered or permitted <br /> area of a private home where the cottage food operator resides and where cottage food products are prepared <br /> or packaged for direct, indirect, or direct and indirect sale to consumers. <br /> 10. Delivery Limitation: Initial if you agree to abide by the following: E,KM <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 /> 11. Owner's Statement: <br /> I, FL-_YGWN ti(A 1V(0 IvVPt1_CbaC*- agree to grant access to the local health department to <br /> conduct an inspection of my cottage food operation (mark one) <br /> L4 "Class A": In the event of a consumer ❑ "Class B": For regular annual facility <br /> complaint or reported food-borne illness inspections and in the event of a consumer <br /> complaint or food-borne <br /> I, EUVSVVA \<A l�L�t'1� MSU-�� i�1L , agree to notify the San Joaquin County <br /> Environmental Health Department prior to modifying my food list, type of operation, and/or method of <br /> selling, distributing, or otherwise providing my CFO products to the consumer or retailers, regardless of <br /> whether the product is sold, consigned, or given away. <br /> AW&L A-—M dk� uk Y-,k \ 3o-20kc] <br /> Owner's Signature Print Name Date <br /> 5of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />