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SANJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> 9. Employee: Initial if you agree to abide by the following: Sy S <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. C <br /> 10. Delivery Limitation: Initial if you agree to abide by the following: N > <br /> 1 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. Own�1(�er's Statement: (�� <br /> I, 1 I VI V OvV\ 1J'I�QIU kJ agree to grant access to the local health department to <br /> conduct an inspection of my cottage food 6peration (mark one) <br /> ❑ "Class A": In the event of a consumer If "Class B": For regular annual facility <br /> complaint or reported food-bome illness inspections and in the event of a consumer <br /> ( '1' complaint or food-borne <br /> I, SI IVi Q �/� 0'f ZAJ V 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. c�I <br /> c,, T- - Jp �Vi) AyAI/L otom! 12,rl22 <br /> Owner's SignaaTure J Print Name Date <br /> 5 Of <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />