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SO JOAQUIN Environmental Health Department <br />---COUNTY <br />7. Owner's Statement: <br />- <br />SriNk VIJ (Y1‹._S , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />lEr"Class A": In the event of a consumer I=1 "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 />I, S7-6-\t6 v‘i 15 ' icAS3 , 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 /> <br />1' <br />1-VVL <br />Owner's Signature <br /> <br />84 r r -7/d3 <br />Print Name ate i <br /> <br />EHD 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM