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Environmental Health Department <br />7. Delivery Limitation:ni <br />8. Owner’s Statement: <br />, agree to notify the San Joaquin County Environmental <br />2 of 2 <br />3/4/2026 <br />Date <br />[El “Class A": In the event of a consumer <br />complaint or reported food-home illness <br />ConlaJ<» Wb««l •■fl <br />MimI« in u kiulwn Hud i» Mil nul fr«« <br />Kai UI 0*0fl) <br /> "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />MADE IN A HOME KITCHEN <br />l-urinil ID •ri002783fl <br />I»MM1<I in Cownit San Joaquin <br />Ownerfs Signature J <br />Diana Jennings <br />Print Name <br />SAN JOAQUIN <br />COUNTY <br />. Diana Jennings ....... u'■___________________________________, agree Io grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />I,Diana Jennings . 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 />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, all Class A' and <br />‘Class B CFO products must be delivered directly (in person) to the customer Ttie 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 aie regulated by. and subject to. CDPH registration and state and federal requirements <br />Made in a Home Kitchen <br />Penult ID M* 10027838 <br />Kmii il hi ( •mniv of Sail J>i.«|iiiii <br />Crcolwc Cookica by Diana <br />Cookie inoteuents Enncned unWeacr.ed e^eat floutlwheat Hour n,aan reduced won <br />tmamine noro nitrate rioonaon rone koi'M tea oat*y nour sugar outteripasueunzea <br />creamfmuk; salt;sea sail) oiga^'C egg* sa'1 baking powder pure .amlla e.!ract(«aniHa <br />bean ertracthes in water alcohol (35%) vegetable snoctenirg organic Cacao powder <br />long Ingredrents Powdered sugar(»ugar com starch) water menngue powdenmodified <br />food sU'ch egg AMes sugar guma'atur sodium aluminum sulfate atnc aod cream of <br />tartar vanillin) Corn syrupjeorn syrup salt vamita) pure vanilla e.trartivanilla bean <br />eiBacti.es m wa’er alcohol (35%) <br />Contains W>eat egg m> <br />Made in a kfchen that -s NOT NUT FREE <br />Net VM 302(85 0*9g) <br />Creative Cookies by Diana <br />IngndtntD I rui.brd unbkathed «l>c.l npiwutwat (lour nxtu-eil inw thununc ami niuotc. rtbvlbiui <br />hi u mulicd hark-) Oirur uiou burt.mprunKucil cmadimilkiull oryvn. bnwn Mpar uli tukiifl <br />tkar tfiubuhin .unilLi txira«i|»al« akohil 11 '••naniflpa bm! rthw •Hihtul fbuitmia. •n.l.eyi. Mid <br />k tn| Inpcdicniv Powdered wpriuipir. i«rr. VaiJil maBflue poadenmodified |i»xl JtuvK efl? «b>tcv wpr <br />guui .ran. uMtsunaiummum sntlslc cfliK Mid crr»n•>(tarur vmillinii.rn .trvpr.om .snip uli. xarnlUi natural <br />jrul utila ul Ibwraqt t••MJ dw