Laserfiche WebLink
RECEIVED <br /> SAN JOAQUIN COUNTY <br /> ?��°�Q,��n.-�`rMAY 17 2018 <br /> ENVIRONMENTAL HEALTH DEPARTMENT NVlltONNIh:NTaL HEAL <br /> LIQ1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sicehd.com I� f�r�RtJV1ENT <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Busines Na Owner Name: Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Website(If applicable): phone: <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: <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 <br /> growth 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 <br /> of ingredients(attach separate page if needed). <br /> Food List: <br /> o� G�lcxX�O�2 <br /> r /l/IwJi,n <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 <br /> product is made). <br /> 5. Water Source: <br /> Please check what type of water source is being used at the CFO: <br /> City Water ❑ Private Well* <br /> `If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br /> EHD 16-29 7127117 1 CFO REGIPERMIMNG RENEWAL FORM <br /> p r-L�LV3 7 4 s' z <br />