Laserfiche WebLink
SAN.JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greotness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> 6 kV1-T►" _ +<--) C J nA l K2±7-aK I`n n <br /> CFO Physical Address: CFO City. CFO Zip: <br /> C1 N14 Chn `L L_ c,A i 9562LID <br /> Website(If applicable): Telephone: <br /> 1:' ;R Trr'aI(:� com aD°I -4gQ - V t4 Ll <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $146 .❑' "Class B" (Direct& Indirect Sales)$292 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: CA <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: no <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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> EHD 16-296/1/18 1 CFO REG/PERMITTING RENEWAL FORM <br />