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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />7. Owner's Statement: <br /> <br />utk-vn ok IV\ W'O , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />71C1Class A": In the event of a consumer <br />complaint or reported food-borne illness <br />El "Class B": For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-borne illness <br />I, ?(VAtr1.0\ nAr , agree to notify the San Joaquin County Environmental <br />Hea th 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 />0 ner's Signature <br />XLkktruk Mon 5/Wiel-if <br />Print Name ate <br />EHD 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM