Laserfiche WebLink
SANJ O A Q U I N Environmental Health Department <br />COUNTY <br />9. Employee: Initial if you agree to abide by the following: MA <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: MA <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 direct[ (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 />Mohamed AbouSamaha <br />I, , 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 QJ "Class B": For regular annual facility <br />complaint or reported food-bome Illness inspections and in the event of a consumer <br />complaint or food-bome <br />Mohamed AbouSamaha '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 />Owner's Signature Print Name Date <br />sofs <br />EHO 1&27 W9117 CFO REGMERMn-rING FORM <br />