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A <br /> SA N s I O A Q U I N Environmental Health Department <br /> --COUNTY--- <br /> 7. Owner's Statement: <br /> I, Ll11d 1 Z UK 1 OA agree to grant access to the local health department to <br /> conduct n inspection of my cottage food operation (mark one) <br /> ❑ "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, agree to notify the San Joaquin County Environmental <br /> Heal Departme t 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 /> i - a 5 <br /> is Signature Print Na a Date <br /> EHD 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM <br />