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SAN,JOAQUIN <br /> <br />Environmental Health Department <br />7. Owner's Statement: <br />A/PAY 7 —(671 , agree to grant access to the local health department to <br />conduct an inspection of my c,Ottage food operation (mark one) <br />\lki'Class A": In the event of a consumer 0 "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,,y ,agree to notify the San Joaquin County Environmental <br />Health Department prior to iodifying 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 />Afana' re/* <br />Print Name Owner's Signature <br />/ <br />Date <br />El-ID 16-29 6/27/22 2 CFO REG/PERMITTING RENEWAL FORM