Laserfiche WebLink
opquiry.c <br /> SANtJOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> i <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> F <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> G l IW1 V//(// / N1141 F-L/'V Owner Name; / ' ,vV/ / WL Date: <br /> CFO Physical Address: FO City: "µ�v'A CFO Zip <br /> wWebsite Ilf PP able : ^I� <br /> rJ ktLl , / <br /> IV <br /> 1. /Categories: <br /> Vi <br /> ❑ "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: <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT A OWED. 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 /> 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 S urce: <br /> Pleas check what type of water source is being used at the CFO: <br /> ity Water ❑ Private Well' <br /> if private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br /> 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 />