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Pe P <br />kun <br />PLAIN <br />Sourdough, <br />Sourdough, Sanclu)-1-1, <br />Loa,: <br />Kkemzek Poof <br />F1RmEN ,ED SOuRD0u0,4 <br />SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />7. Owner's Statement: <br />S110 , agree to grant access to the local health department to renda <br />conduct an inspection of my cottage food operation (mark one) <br />/d "Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />ID "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />, 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 away. <br />Owner's Signature <br />env& 8IicIr 003 <br />Print Name Date <br />greru(k AaPer <br />114REDIEWS tiDlIE WHEA11101JR, hE 1lDDR, BREAD [LOUR, WAIER, <br />HMAIMAN PINK SALE <br />contains: wheat <br />?yerkia Shafer PA S Church Si Lodi, Cu 9S1.0 <br />yaw isie olf roof toln 16 nekisfroof 109 -649-51111 <br />1111111.1 IN A 1111NIE KITHIEN <br />Parui * 003‘ Issue.A in Son loarn Gunij <br />INUEDIENIS 001E idIIM i1E IIOLiL I E0111.8RIAD RM. MILK, Et, NOW , <br />MEAN Olt, NIMAWAN PINK ikp <br />contains: wheat, hour. dal r\ <br />Frenda S Church ,\t Qti, CA %NO <br />law) kneadcfroof om kneafroch 109-6119 -SIILI <br />Ni WE IN \HOME klIVIIEN <br />P an! * 00A) Issucci in San ba9uin Counlj <br />END 16.296127(22 2 CFO REG/PERMIT 1 INO RENEWAL FORM