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SAN JOAQUIN <br /> <br />Environmental Health Department <br />7. Owner's Statement: <br />0 \(z_ cok 1, <br />conduct an inspection of my cottage food operation <br />tg "Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />0 "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />, agree to grant access to the local health department to <br />(mark one) <br />, agree to notify the San Joaquin County Environmental <br />Health Department prior to modifying my food list, type of operation, and/or method of selling, distributing, or <br />otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br />consigned, or given away. <br />Jos\Ava, \)c-,\\Q. <br />jositivol 4),1 Pk t(2- 06 -19 -ZCIaS <br />Date ner's e Print Name <br />EHD 16-29 6/27/22 2 CFO REG/PERMITT1NG RENEWAL FORM <br />