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444[ry-r <br /> SAN JOAQUIN COUNTY <br /> F, �1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone;(209) 468-3420 Fax;(209)464-0138 Web:www.sioov.drG/ehd <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM L� <br /> CFO Business NaRIL� /�r, I � R Date: <br /> CFO Physical Address: C City: CFO Zip: <br /> Website(If applicable): Telephone: <br /> i,J�. ��.��Jr�o�a-141 ed 2 <br /> 1. Categories: <br /> X "Class A" (Direct Sales Only) $125 ❑ "Class B" (Direct& Indirect Sales) $250 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT AL WED. <br /> Only foods that are defined as"non-potentially hazardous"are approved for preparation by a Cottage Food <br /> Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br /> growth that could be a cause of food-borne illness. <br /> 3. Products: <br /> Provide a list of all products you are preparing. If preparing jams,jellies, or nut butters include a list <br /> of ingredients (attach separate page if needed). I <br /> Food List: \ <br /> 1A <br /> 96g2,y� �2 <br /> All <br /> 4. Product Labeling: <br /> dude 1 D �'na • *i.. gf2 <br /> w'+wu n°w. Cook 2�� k, �"e24 C u sa. <br /> Attach two labels to this form for two of you ,, ,,; nada egraa_e ° y3g37ty yr.��� �`� • <br /> product is made). .f. e°ge waaa of/l° ��& n°°°b we• dj•ea <br /> Aef ngpogw44e o4 r>.Dane/ry4 btr/ �mO+e°a.".."&'''bek°a°a dg <br /> %q �n„Wve•^i A•°� <br /> 5. Water Source: �/ Dkag daft o��°�y°w nr°,•ym m` °°ea s2 °P`mow / <br /> Please check what type of water source is being use <br /> El City Water �}'Frivate Well' <br /> `If a private well, attach all updated water sample results(including quarterly bacteria and Nitrate results.) <br /> EHD 15-291/23/14 1 CFO REG/PERMRTING RENEWAL FORM <br />