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SA N J O A Q U I N Environmental Health Department <br /> COUNTY <br /> 7. Owner's Statement: <br /> I,�i�_ <br /> -t2� a� 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 ❑ "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�a)C-t-D 0 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 /> erwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br /> ori igned, or given away. <br /> Owner's Signa ure Print Name Date <br /> EHD 16-296/27/22 2 CFO REG/PERMITTING RENEWAL FORM <br />