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   CCDEH Model CFO Registration/Permitting Form (Updated 12‐21‐2012)                                     Page 5 of 5  <br />  <br /> <br />10. Gross Annual Sales: Initial if you agree to abide by the following: ________ <br /> <br />I understand that I will lose my CFO status and will need to become permitted in a <br />commercial facility if my CFO business exceeds the following gross annual sales figures for <br />the calendar years in the following table: <br /> <br /> Calendar Year Gross Annual Sales <br />In 2013 ........................................................... $35,000 <br />In 2014 ........................................................... $45,000 <br />In 2015 and in subsequent years ................... $50,000 <br /> <br />11. Delivery Limitations: 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 <br />“Class A” & “Class B” CFO products must be delivered directly (in person) to the customer. The <br />CFO products may not be delivered via US Mail, UPS, FedEx or using any other indirect delivery <br />method as this is regulated/subject to CDPH registration and state and federal requirements. <br /> <br />12. Owner’s Statement: <br /> <br />I, , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one): <br /> <br /> “Class A”: In the event of a <br />consumer complaint or reported <br />food-borne illness <br /> “Class B”: For regular annual facility <br />inspections and in the event of a <br />consumer complaint or food-borne illness <br /> <br />I, , agree to notify Alameda County Department of <br />Environmental Health prior to modifying my food list, type of operation, and/or method of <br />selling, distributing, or otherwise providing my CFO products to the consumer or retailers, <br />regardless of whether the product is sold, consigned, or given away. <br /> <br /> <br />Owner’s Signature Print Name Date <br /> <br />OFFICE USE ONLY <br /> <br />AMT REC'D________________ DATE REC'D_________________ <br />DATE OF PAYMENT_____________ PAYMENT TYPE: (1) CASH (2)CHECK (3) CREDIT/DEBIT <br />CHECK#_______________ DATE OF CHECK_______________ INVOICE#__________________ <br />OW #____________________FA#_____________________PR #______________________ <br /> <br /> <br />DATE APPROVED & BY <br /> <br />OFFICER:____________________________________________ <br />