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SAN JOAQUIN <br />COUNTY - <br />7. Owner's Statement: <br />Environmental Health Department, <br />I, cj�enja t7rar1 ot'J , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />21"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 />I, GI rl dG r an I✓( i ti , 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 />Glenda haAatm <br />Print Name <br />uate <br />EHD 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM <br />