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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />7. Owner's Statement: <br />1,C14-clzie 5e6L , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />1 ''Class A": In the event of a consumer 0 "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 />1 , che it , 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 />0/Z <br />Print Name <br />_30 -2,0 <br />Date Owner's Signatu <br />EHD 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM