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SANJOAQUIN <br />COUNTY <br />Environmental Health Department <br />7. Owner's Statement: <br />Qpr)Vo\o% crOAACAD , agree 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 D "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 />c- v' t c-_ , agree to nobly 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 />2!50 s Signature <br /> <br />V)A0V; fcAnce C311)-3 <br />Print Name Dat <br /> <br />END 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM