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• <br />SAN JOAQUIN -ouN, <br />Environmental Health Department <br />n Lzo_ ( co 5 /I <br />er's Signature nnt Name Date <br />Delivery Limitation: Initial if you agree to abide by the following: <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, ( _\ t --)(ctZWt 0_0 ,agree to grant access to the local health department to <br />conduci an inspection of my cottage food operation (mark one) <br />111 "Class A": In the event of a consumer "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 />I, \-AAnckt at2 ai , 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 />2 of 2