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<br /> SA N,d O A Q U I N Environmental Health Department
<br /> --COUNTY
<br /> 7. Delivery Limitation: Initial if you agree to abide by the following: CA
<br /> 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 /> I, L It FP_/E% �eG L C✓� agree to grant access to the local health department to
<br /> conduct an inspection of my cottage food operation (mark one)
<br /> ❑ "Class A": In the event of a consumer 15d "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 /> I, 6,14E24E SGC If 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.
<br /> d,4-, fffE2le S G&E2
<br /> Owner's Signature Y Print Name Date
<br /> Cherie Segler
<br /> 17971 N Tretheway Rd
<br /> Lockeford,Ca 95237
<br /> Ingredients:Unbleached flour(wheat flour,niacin,reduced iron,
<br /> thiamine,mononitrate,riboflavin,and folic acid),Fruit,Sugar,
<br /> Vegetable shortening,Cornstarch,Salt,Cinnamon,Nutmeg
<br /> Contains:Wheat
<br /> Made In A Home Kitchen
<br /> Oiei7e s(Pies Permit#PT0025226
<br /> Issued In San Joaquin County
<br /> Net Wt 2.5lbs(40.0 oz
<br /> Cherie Segler
<br /> 17971 N Tretheway Rd
<br /> Lockeford,Ca 95237
<br /> Ingredients:Unbleached flour(wheat flour,niacin,reduced iron,
<br /> thiamine,mononhrate,riboflavin,and folic acid),Fruit,Sugar,
<br /> Vegetable shortening,Cornstarch,Salt,Cinnamon,Nutmeg
<br /> Contains:Wheat
<br /> Made In A Home Kitchen
<br /> Chen s Tes Permit#PT0025226
<br /> Issued In San Joaquin County
<br /> Net Wt 2.5lbs(40.0 oz
<br /> 2of2
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