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P 111111111111r 11116410411111.411ha k..-g11111111M /a•WWI 117 MIMI "' '04k <br />7 Owner's Statement <br />15c95612A ri <br /> <br />agree to grant access to the local health departm*ot <br /> <br />f.onctxt an inapecaon or my coinage krod operation (mart ones <br />f <br />iCC-Cilklia A - ki the event ol a consort*/ <br />cornptarrx or retxxxici tood borne illness <br />;I Claes a". For reguLar annual tacky impactions <br />and in the event of a ccosumer complaint or <br />food oorne inesz <br />1 rb9da•10V(eA--- agree to notify the San Joaquin County Envwonmental <br />Health Department prior to modifying my taxi Irs1 type of operabon ;Ind or metfuxi of seffsny drstrtruttny cx <br />Oillof *WO pedbny my CFO products iu the consurniir or returtrirr toga:dies% or whethef the pftiCluct iokl <br />,-orrsoped or green away <br />I 1 ( 4435114*N CV; S•T <br />Print Nom Date <br />II .sisiv zi CFO REOPEIRIMIT r+. , <br />or.mm•••• . Mr_ ma le ...slaw vs. Mt A•Mmi woe 'gm. • disdANININION•Mains 411=11111.... • mnmaft