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SA/{N I O A Q I U I I N Environmental Health Department <br /> COUNTY- <br /> 9. <br /> OUN TY '`I <br /> 9. Employee: Initial if you agree to abide by the following: C <br /> I understand that I may not have more than one full-time equivalent cottage food employee, not including a <br /> family member or household member of the cottage food operator, working within the registered or permitted <br /> area of a private home where the cottage food operator resides and where cottage food products are prepared <br /> or packaged for direct, indirect, or direct and indirect sale to consumers. <br /> 10. Owner's Statement: <br /> I, MC<nhs Amv'e4agree to grant access to the local health department to <br /> conduct an inspection of my cottage food operation (mark one) <br /> ❑ "Class A": In the event of a consumer )�,"Class B": For regular annual facility <br /> complaint or reported food-borne illness inspections and in the event of a consumer <br /> complaint or food-borne <br /> I, RkkW-A-�,S (Arrcre,fiP- 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 avy4j . <br /> Z3 � Z3 <br /> f f Owner's Signature Print Name Db to <br /> 5 of 5 <br />