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SAN JOAQUIN Environmental Heakre;�, Vea tment <br /> r; C ---COUNTY-- <br /> r c':'l oi?"' Vrc Cil'ness gro4vs here. A <br /> 2019 <br /> COTTAGE F®®® OPERATIONS (CF®) 'EF/VV/&O <br /> pERMMENr,4 <br /> REGISTRATION/PERMITTING RENEWAL FORM SERV/C scry <br /> CFBusiness Na OwnrTe:aDate: ^ <br /> &5k� <br /> _714 <br /> CFO Ph si al Address: CFO Ci CFO Zip: <br /> 161L 0 1ti1 L 129ffy Lk skr o41 <br /> Website(If applicable): Telephone: <br /> 'l. ate Dries: Orders 0 5(,coc .s <br /> �rtthd co rn <br /> "Class A" (Direct Sales Only) $155 W4 "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 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 /> 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 /> Plea e 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 />