Laserfiche WebLink
s <br /> °AaU'"c SAK.JOAQUIN <br /> °z� Environmental Health Department <br /> COUNTY <br /> iFoaP/ Greatness grows here. <br /> COTTAGE FOO® OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> V�i x�� <br /> O Busin s me: �"Owner Name: Date: <br /> CFO Physical Address: CF City: CFO Zip: <br /> �-E'S x-4-3 fF-rvL Jeno <br /> Website(If applicable): T lephone: <br /> L'AJ <br /> L_J <br /> LA <br /> 1. Categories: <br /> a <br /> 1--l�Class A" (Direct Sales Only) $1e� lnitial <br /> ❑ "Class B" (Direct& Indirect Sales) $310 <br /> 2. Prohibited Items: if you agree to abide by the following: <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of food-borne illness. <br /> 3. Products: <br /> Provide a list of all products you are preparing. If preparing jams,jellies, or fruit butters include a list of <br /> ingredients (attach separate page if needed). <br /> Food List: <br /> 1�T rl <br /> JA MLJ <br /> 4. Product Labeling: <br /> Attach two labels to this form for two of your CFO products (only one label is Ma esah <br /> made). �4. 40 (� <br /> nea/90 ed b �J� <br /> 5. Water Source: �",l%e��aedo,e V, °'�4; %',�s4��2 <br /> Please check what type of water source is being used at the CFO: 3� <br /> YP g 9�der,d��5 vnsu�r�hlr nia�0 iin <br /> ity Water ❑ Private Well* z`�fa/ <br /> *If a private well, attach all updated water sample results (including quarterly bacteria an., <br /> 6. Food Processor Course: <br /> Attach food handler certification for owner and each individual that were not submitted with initial application <br /> (including family members and/or employees). <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />