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SAN JOAQUIN <br />COUNTY <br />Environmental Health Departnient <br />7. Owner's Statement: <br />vd.e, ("V r 0 , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />‘ <br />`Class A": In the event of a consumer <br />El "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 />, 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 a ay T.& <br />Owner's Signatu e <br /> <br />)(k.ltrnck rwo Li/a /i/2. g 3 <br />Print Name te <br /> <br />1, (4,1trytiVLuMJ <br />END 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM