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SANJQAQUIN Environmental Health Department <br /> --COUNTY— <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> �kk�-Tr(- � C-) 0-Vn 1I til In 7-0A62n <br /> CFO Physical Address: CFO City: CFO Zip: <br /> q N. �A u+_Chn S c�+ L- c A 9562 <br /> Website(If applicable): Telephone: <br /> �r AMTrP S c©m avq A20 - Vqq <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $146 J2' "Class B" (Direct& Indirect Sales) $292 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: C.' Xi <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <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 growth <br /> 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 fruit butters include a list of <br /> ingredients (attach separate page if needed). <br /> Food List: rn a I t -4e e <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 /> 1868 E. Hazelton Avenue i Stockton, California 952051 T 209 468-3420 i F 209 464-0138 1 www.sir-ehd.com <br /> EHD 1629 8/1/18 1 CFO REG/PERMITTING RENEWAL FORM <br />