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COMPLIANCE INFO_2019-2020
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1600 - Food Program
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PR0542092
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COMPLIANCE INFO_2019-2020
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Entry Properties
Last modified
5/13/2021 4:39:06 PM
Creation date
7/24/2019 1:06:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019-2020
RECORD_ID
PR0542092
PE
1609
FACILITY_ID
FA0024172
FACILITY_NAME
BLACK STRAWBERRY BAKERY
STREET_NUMBER
1533
STREET_NAME
BADGER
STREET_TYPE
WAY
City
TRACY
Zip
95304
CURRENT_STATUS
01
SITE_LOCATION
1533 BADGER WAY
P_LOCATION
03
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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1zSANsJ0AQUIN Environmental Health Department <br /> i .. _ ' {�' _COUNTY— <br /> Greotness <br /> grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner N e: Dat <br /> u bar t � Alda• Tarn C� 1 / <br /> CFO Physical Address: FO City: CFO Zip: <br /> l S�� IP a44 ger- WAY 71-0,cA j 9 S3 D'`} <br /> Website(If applicable. Telephone: <br /> 199 a C k StVA4 V✓e+'y�/�a�ery . Cb M ) <br /> 1. Categories: <br /> x "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: 60 <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 /> r <br /> 0A1 A4im ( 0 <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 /> City 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 />
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