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?` SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT IygR <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 E4 32 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sicehd.corrw� <br /> T <br /> NR, <br /> cti <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name:: Owner Name: pp•• Date: <br /> )/ V <br /> CFO Physical Address: ll CFO City: CFO Zip: <br /> Website(If applicable): Telephone: <br /> 1. Categories: d <br /> ❑ "Class A" (Direct Sales Only) $125 ( "Class B" (Direct& Indirect Sales)$2615- <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 /> r <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 IX Private Well* <br /> 'If a private well, attach all updated water sample results(including quarterly bacteria and Nitrate results.) <br /> EHD 16-29 6129/2015 1 CFO REG/PERMITTING RENEWAL FORM <br />