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CFO REOPERMITING RENEWAL FORM END 16-29 6127/22 2 <br />Lauca mt.A.Ick VI;crit_ssa0 s <br />Owner's Signature Print Name Date <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />7. Owner's Statement: <br />1, LA I, Ck , agree to grant access to the loca health department to <br />conduct an inspection of my cottage food operation (mark one) <br />N'Class A": In the event of a consumer E.] "Class B": For regular annual facility inspections <br />complaint or reported food-borne illness and in the event of a consumer complaint or <br />food-borne illness <br />I, L-OTA , agree to notify the San Joaquin County Environmental <br />Health Department prior to modifying my food lis:, 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 />consign , or given away.