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SA N X10 A Q U I N Environmental Health Department —COUNTY-- S. Employee: Initial if you agree to abide by the following: RS I understand that I may not have more than one full-time equivalent cottage food employee, not including a family member or household member of the cottage food operator,working within the registered or permitted area of a private home where the cottage food operator resides and where cottage food products are prepared or packaged for direct, indirect,or direct and indirect sale to consumers. 10: Delivery Limitation: Initial if you agree to abide by the following: RS I understand that I may accept orders and payments via the intemet, mail or phone. However,all"Class K and "Class B"CFO products must be delivered directly(in person)to the customer.The CFO products may not be delivered via the United States Postal Service, UPS, FedEx, or using any other indirect delivery method as deliveries are regulated by,and subject to, CDPH registration and state and federal requirements. 11. Owner's Statement: 1,EMIR SAM t)DR4Le} agree to grant access to the local health department to conduct an inspection of my cottage food operation (mark one) Class A": In the event of a consumer ❑ "Class B": For regular annual facility complaint or reported food-bome illness inspections and in the event of a consumer complaint or food-bome I, RAMIA- SAM,)DRALA agree to notify the San Joaquin County Environmental Health Department prior to modifying my food list,type of operation,and/or method of selling, distributing, or otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, consigned, or given away. OIr e1 S FtM YA $A MS Dkrt,a 0 l I Ki 124 2-2- Owner's 2Owner's Signature Print Namb Date 5 of EHD 1627 6/29117 CFO REGIPERMf1TING FORM