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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />9. Employee: Initial if you agree to abide by the following: <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 />Delivery Limitation: Initial if you agree to abide by the following: <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 />OWner's Statement: <br />I, Pro\b-r2P( Nd cunq , agree to grant access to the local health department to <br />4 conduct an inspection of cottage food operation (mark one) <br />"Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />Pcyv\\,,,kg , agree to notify the San Joaquin County <br />Environmental Health pepadment 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 />c(c/vv`--- \40ALe( p 40, 0 Z-73 <br />Owner's Si nature.) Print Name Date <br />EHD 16-27 6/29/17 <br />5 of 5 <br />CFO REG/F'ERMITTING FORM <br /> <br />"Class B": For regular annual facility <br />inspections and in the event of a consumer <br />complaint or food-borne <br />Scanned with CamScanner