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1 <br /> A : HON Environmental Health Department <br /> 2 Z <br /> COUNTY— <br /> °q Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> 1 CFO Bu si ass Na 9- 04hind- N4 O ner N e: OC'1-T I I Date: <br /> Physics Addre tolfiag City: ►/ l /� n CFO Zip: UX o <br /> ebsite(If applicable): Telephone: <br /> �bg - xa3 - aa3� <br /> 1. Categories: <br /> Y "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales)$310 <br /> V�.yra�Qf.� O�r <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 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 /> ro <br /> r e a <br /> Or <br /> 4. Product Labeling: <br /> Attach two labels to this form for two of your CFO products (only one label is required if only one product is <br /> made). <br /> 5. Water Source: <br /> le a check what type of water source is being used at the CFO: <br /> City Water ❑ Private Well* <br /> *If a private well, attach all updated water sample results(including quarterly bacteria and Nitrate results.) <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 />