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Heith Department prior to mod otherwise providing my CFO pr consigned. or given ay. Date SAN JOAQUIN Environmental Health Department Delivery Limitation: Initial if you agree to abide by the follow' I understand that I may accept orders and payments via the internet, mail or phone. Howeve "Class B" CFO products must be delivered directly (in person) to the customer. The CFO prod s may not be delivered via the United States Postal Service, UPS, FedEx, or using any other indirect delivery method as deliveries are regulated by, and subject to. CDPH registration and state and federal requirements. Owner's Statement: I, /7( - agree to grant access to the local health department to conduct an insp ction of my co ge food operation (mark one) fl "Class A": In the event of a consumer complaint or reported food-borne illness rp k""Class B": For regular annual facility inspections and in the event of a consumer complaint or food-borne illness lass A" and , agree to notify the San Joaquin County Environmental ng my food list, type of operation, and/or method of selling, distributing, or ducts to the consumer or retailers, regardless of whether the product is sold, Print Name patent( ,cund/ Rye 6 Seed Sourdough Made In A Home Kitchen / Permit #PT0028468 Issued in San Joaquin County Joe Kelley 894 Golden Pond Dr, Manteca, CA 95336 kelleyii@aol.COM Ingredients: All Purpose Flour, Bread Flour / (Unbleached hard red wheat flour, Malted barley / flour) Whole Wheat, Caraway Seeds, Sun flower, / Flax Seed, Quinoa, Pumpkin Seeds Water, Yeast, Salt Net Wt 2 lbs (970g) „/ felinertt. 9U114 r l'Ak‘. Valley Smoked Cheddar Sourdough Made In A Home Kitchen Permit #PT0028468 Issued in San Joaquin County Joe Kelley 894 Golden Pond Dr, Manteca, CA 95336 kelleyii@aol.com Ingredients: Bread Flour (Unbleached hard red wheat flour, Malted barley flour) Whole Grain Rye Flour, Water, Smoked Cheddar Cheese, Yeast. Salt Net Wt 2Ib 4oz (1021g) 2 of 2