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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />Deliver)/ Limitation: Initial if you agree to abide by the following. <br />I understand that I may accept orders and payments via the Internet, mail or phone. However, I "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 />, , , <br />,, z____ , /r- e_rve-1 c ,,KkiA6c -,_ , , , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />eiSf"Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />D "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />, <br />I, I 4 ,c)7:' /7 A. , , k.:. , /kr c <br />, agree to notify the San Joaquin County Environmental — L...- - <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 />consiri, or iven away. <br />(_..Y Owner's Signature Print Name Date <br />2 of 2