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SAN JOAQUIN f I1V!I 'iw.nrMl f >e’pvutme.it <br />8 Qwner‘s Statement; <br />, agree to grant access to the local health department to <br />Pr^ Name <br />2 of 2 <br />□ '‘Class A": In the event of a consumer <br />complaint or reported food-bome illness <br />i. AvavA C , agree to notify the San Joaquin County Environmental <br />Health Department poor 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 />^^^Own^^^nature <br />fc? “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />7 DcliyciY_^iniH«t’PfV; Initial if you aarw to •bld© by th© following <br />i rr--c.i ■»-,,1 !h -',Rv |v»vsvc!it<? via tri© itrtr’inrf moil or phnn© Hnwfvoi r»H Class A rind <br />p cf O p'l'.vuftt n-msl be de'avred d.rectly t'n person) to the rustomer tlie CFO pmdur tr, may no! b© <br />rtr-iv«' —d th© in States Postal Sendee UPS FedEx or using any other mdimr t delivery rnnlhnd as <br />at by and subject to CDPH registration nod State and federal requirements <br />Date <br />* t/\V(\vA . agree to gra <br />conduct an iqApectron of my cottage food operation (mark one)