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A N 1 D A Q X11 N Environmental Health Departi��ent <br /> t_l i"i 1 V <br /> 11. Owner's Statement: <br /> I, C)6cl , - ' 'Nt , . , agree to grant access to the local health department to <br /> conduct an inspection o my cottage food operation (mark one) <br /> FC'"`Class A": In the event of a consumer El "Class B": For regular annual facility <br /> Complaint or reported food-borne illness inspections and in the event of a consumer <br /> complaint or food-borne <br /> I, Cin ���� L ` � - 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 /> Owner's Signature Print Name Date <br /> EHD 16-27 6/15/18 5 CFO REGIPERMITTING FORM <br />