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1868 E. HazeIton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464- <br />S AN JOAQUIN 0138 I www.sjcehd.com Environmental Health Department <br />COUNTY <br />Delivery Limitation: Initial if you agree to abide by the following: ukp <br /> <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, Ursula Kemp-Paden , agree to grant access to the local <br />health department to conduct an inspection of my cottage food operation (mark one) <br /> <br />DX "Class A": In the event of a consumer <br /> CI "Class B": For regular annual facility inspections <br /> <br />complaint or reported food-borne illness and in the event of a consumer complaint or food-borne <br />illness <br />I, Ursula Kemp-Paden , agree to notify the San Joaquin <br />County 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 whether <br />the product is sold, consigned, or given away. <br />Ursula Kemp -Paden 09/21/2023 <br />Owner's Signature Print Name Date <br />2 of 2