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SAN JOAQUIN Environmental Health Department <br />Employee: Initial if you agree to abide by the following: <br /> <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 />Owner's Statement: <br />1, Mrpirws RI ERS J Kt) a R ,agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />VCIass A": In the event of a consumer c] "Class B": For regular annual facility <br />complaint or reported food-borne illness inspections and in the event of a consumer <br />complaint or food-borne <br />I, ME- e NfiKgHI TRUK ULU R , 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 />tqfEbihKgli TRU kV LI- n 6 ig /62 N 2 3 <br />wner's Signature Print Name Date <br />5 of 5