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Owner. ature <br />SAN JOAQUIN <br />-- <br /> <br />COUNTY <br />Environmental Health Department <br />7. Owner's Statement: <br />i, -0.--. -\\ -, ,)t•-\ c')0 CO , agree to grant access to the local health department to <br />conductan inspection of my cottage food operation (mark one) <br />N "Class A": In the event of a consumer rj "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 />-e--,77/"---'fii-YL----7agree to notify the San Joaquin County Environmental <br />Health De artthent <br />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 away. , <br />Print Name , Date <br />2 CFO REG/PERMITTING RENEWAL FORM <br />END 16-29 6/27/22