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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />7. Owner's Statement: <br />I, JC:596(bAr C-SOC C)(I'D , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br /> <br />EKCIass A": In the event of a consumer "Class B": For regular annual facility inspections <br /> <br />complaint or reported food-borne illness and in the event of a consumer complaint or <br />food-borne illness <br />tb,{ o Co %(' r 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 />otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, <br />consigned, or given away. <br /> <br />CA) WA-14D br ,Dcov-rp 05/01/2023 <br />Owner's Signature Print Name Date <br />END 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM