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SAN JOAQUIN <br />-)lJNTY <br />Environmental Health Department <br />7. Owner's Statement: <br />(.._‘(,,e,k <br />3 I 01 Tagree to grant access to the local health department to 1 . ,r <br />conduct an insp ction of my cottage food operation (mark one) <br />"Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />ss .c 113\.) e <br />16 "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />I, iT{Y\YN , agree to notify the San Joaquin County Environmental <br />Health Departtnent 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 aw <br />2re <br /> -saw <br />Owner' Signature Print Name Date <br />ssei4e Val Z, 07/) q/13 <br />END 18-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM