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Pa NCG2 SANA0AQUIN p <br /> Environmental Health Department <br /> COU NTY <br /> kiF6 Greatness grows here. b <br /> COTTAGE FOOD OPERATIONS (CFO) At " <br /> REGISTRATION/PERMITTING RENEWAL FORM EN 0? ? 0 <br /> VjRoN OJg <br /> CFO Business Name: Owner Name: Date: p�RM `S <br /> CFO Physical Address: CFO City: CFO Zi <br /> `33�A SAN Del Irl F �_� S 2 4-l� <br /> Website(If applicable): Telephone: 16!9 , <br /> � � �� 1 <br /> 916 6 ' 1 <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155 "Class B" (Direct & Indirect Sales) $310 <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 /> S or i- c� Lo I <br /> 4.)Attach <br /> Product Labeling: <br /> 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 /> Please check what type of water source is being used at the CFO: <br /> XCity 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 /> �i 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 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br /> S <br />