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. ~ ' <br /> SAN� �X U� � & KU &U <br /> ��88K� �UUU880UKUUK� ~~����~��/����!�'l- � �� ��� <br /> ~°"""°�= ~"""��~" " "" ^_ ^ *�. . , u <br /> --�OUNTY-- �� �� & ^ �_� �� �� �� <br /> he/e. <br /> ��� 1 1 90�0 <br /> . �u . / ^"^` <br /> ���������� ������ �������U���� /����� <br /> COTTAGE" ".~°~- " ~~~~~~ .~" ~-. ._. . ..~.~~~ (CFO) <br /> ONK8ENT4LHEALTH <br /> ����0�����U�������U�U��U��� ������U ����"~ <br /> " ~~-~~`~° " "^�" " "~~""'" °-"~`^"" " " ""~~~ " ^~-"~°-"""^,~ " ~~^ ~��R[@}T/SERV\CEG <br /> CFO Business Name:� wner Name: Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Vvaunue(Ifopplicable): Telephone: <br /> 5a C2 <br /> 1. <br /> b4 "Class A" (Direct Sales Only) $155 "Class 13" (Oirect& Indirect Sales) $310 <br /> 2. Initial if you agree to abide by the following: <br /> Foods containing oremmn, custard, or meat fiNm0a 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 <br /> cause offood-borne illness. <br /> 3. <br /> Provide o list of all products you are preparing. If preparing jamo,jellies, or fruit butters include a list of <br /> ingredients (attach separate page ifneeded). <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 /> ----'. <br /> u. <br /> Water Source: <br /> Please check what type ofwater source isbeing used at the CFO: <br /> City Water Private Well* <br /> °|f 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 emp|uyees). <br /> 1868E. Hazelton Avenue | Stockton, California &62O5 | T 209468-34201 F 209 464-0.138 1 www.sjcehd.com <br /> �n 0 ^ ' ./ 7��'�/1K �� � <br /> \ '`- o <br />