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�~..' <br /> �~- � � &U Y � 8 � � &] <br /> ��� �� J � U� Q� � �� Environmental Health Department <br /> ---COiJNTY�---' <br /> ~^ - <br /> �'�n »�s <br /> COTTAGE ������� �������U����� ������� <br /> - - ' ' ' '---- FOOD'~~~ `~~ ~-^ ~ ^ ^ ~^~^~~~ (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM' <br /> CFO Business Name Owner Name: Dom: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> ,& � GT h4ANTtCy\ 96-337 <br /> Website(If appncame): Telephone: <br /> 1' <br /> ��' <br /> El ^C�nsA" (Direct Sa�oOnk) $155 �� "Class B^ (Direot& Indirect Sales) $310 <br /> 2' Initial if you agree to abide by the fo||oxvin <br /> Foods containing cnammn, custard, ormeat 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 offood-borne illness. <br /> 3. <br /> Provide olist ofall products you are preparing. |fpreparing jams,jellies, orfruit butters include alist of <br /> ingredients (attach separate page ifneeded). <br /> Food List: <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 /> -' <br /> Water Source: <br /> Please check what type ofwater source isbeing used at the CFO: <br /> qCdxVVater F� 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 emp|oyoes), <br /> 1868E. Hazelton Avenue I Stockton, California 952U51 T 209 468-34201 F 209 464-0138 1 vmxmv.yjcehd.00m <br />