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SAN JOAQUIN <br />COUNTY <br />Delivery Limitation: <br />Environmental Health Department <br />Initial if you agree to abide by the following:M/53 <br /> <br />I understand that I may accept orders and payments via the internet, mail or phone. Direct and Indirect sales <br />may be made in person, via mail delivery, or using any other third-party delivery service throughout the state <br />of California only. <br />Owner's Statement: <br />130 A 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 LII "Class B": For regular annual facility inspections <br />complaint or reported food-borne illness and in the event of a consumer complaint or <br />food-borne illness <br />G-7-? S .. IA/ liktlrc--‘-;• agree to notify the San Joaquin County Environmental <br />Health epartment prior to modifying my food list, type of operation, and/or method of selling, distributing, or <br />otherwi providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br />consigned, or given away. <br />(oft—A/ <br />e•Th <br />C--- /) <br />Owner's Signature Print Name Date <br />2 of 2