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avrH <br /> S A A H O U I N Environmental HeOTHKMent <br /> 1-1 <br /> `, --COUNTY / <br /> 0qc' P . Greatness grows here. 77 / R <br /> DIEL 2 6 7n. <br /> COTTAGE FOOD OPERATIONS (CFO}NVIIl ONIN>IEN'YAL11FAI-rt11 <br /> REG ISTRATIONIPERMITTING RENEWAL FORM""PAR'FiNlLN'F <br /> CFO Business Name: Owner Name: Dte: <br /> Sweet- crumbles 6shcp Siren, A `��� la�lIg <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1a5 sea C7"I'L c,*. ;0wo (P <br /> Website(If applicable): Telephone: <br /> ISO ,Q0,-)— 36oIa <br /> 1. Categories: <br /> 1 "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct (OX Indirect Sales) $310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> Foods containing cream, custard, or rneat 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 frorn 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 /> Co�kses�l 0,V1 YEA mC A (Ol(1-10 cake_. harcl (2aA j./ , ;Wit �,+i S , <br /> S 103 <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 /> Please check what type of water source is being used at the CFO: <br /> YCity 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 />