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Environmental Health DepartmentSANJOAOUIN <br />-----COUNTY------ <br />Print Name <br />31 <br />Date <br />■ ;-y <br />Initial if you agree to abide by the following-. L <br />deliveries are regulated by, and subjec , <br />8. Owner’s Statement: <br />□ “Class B”: For regular annual facility inspections <br />and in the event of a consumer complaint or <br />food-bome illness <br />[V\“Class A”: In the event of a consumer <br />/complaint or reported food-bome illness <br />• D i K 0 /'/’zfc Al Id/ S . agree to notify the San Joaquin County Environmental <br />consigned, or given away. <br />Owner’s Signature <br />..... . <br />■