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F�+pD Z/ <br /> SAN JOAQUIN COUNTY pP�EVEp <br /> ENVIRONMENTAL HEALTH DEPARTMENT REc 1 Zp15 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 FE8 Ncv <br /> C��liFpRutp Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd QV�NCK(P�- <br /> _ TM EP���� <br /> N <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: soee4 Date: cL q— <br /> CFO <br /> �� <br /> I<J <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Website(If applicable): J / / Telephone: <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $125 ❑ "Class B" (Direct & Indirect Sales) $250 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: --C <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 nut butters include a list <br /> of ingredients (attach separate page if needed). <br /> Food List: <br /> Made In a Home Kitchen Made In a Home Kitchen <br /> Sweet Stuff Sweet Stuff <br /> 1674 Ray Wise Ln•Tracy,Ca 95376•(209)969-CAKE <br /> wwW.nlysweetstuff.net 1674 Ray Wise Ln•Trary,Ca.95376•(Z09)969-CAKE -- <br /> www.facebook.com/my.sweetstuf.cupcakes www.mysweetstuff.net <br /> Permit#PT0023098 www.facebook.com/my.sweet.stuff.cupcakes <br /> Green Velvet Cupcake Snickerdoodle Cupcake — <br /> Ingredients:Sugar,Dour,cocoa powder,coffee,vegetable oil. ingredients:Sugar,flour,eggs,buttermilk powder,baking <br /> 7soda,buttermilk powder,baking soda,baking powder,vinegar, <br /> ,baking powder,cinnamon,cream of tartar,vanilla extract, <br /> vanilla extract,salt,green food color,butter,shortening alt,powdered sugar,butter,shortening,heavy whipping cream <br /> 4. Product Labeling. cinnamon,heavy whipping cream Contains:Dairy,eggs <br /> Made in a facility that uses nuts <br /> Contains:Dairy,eggs Net wt.2.5 oz(68g) <br /> Attach two labels to this form for two of y Made <br /> inafa 2i5 oz(bags nunuts one label is , <br /> product is made). Net <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 /> EHD 16-29 1/23/14 1 CFO REG/PERMITTING RENEWAL FORM <br />