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Website (If applicable): Telephone: <br />(so f <br />ed% <br />çëo SANiJOAQUIN <br /> <br />€1.7. COUNTY <br /> <br />\-e: Greatness grows here. <br />Environmental Health Department <br /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br /> <br />Owner Name: <br /> <br />Date: <br />067e/ze,0 <br />CFO Zip: <br />95-aq ( <br /> <br />(56z-er A-Fr/4x 9 <br /> <br />I/067v N74672 <br /> <br />CEO Physical Address: <br /> <br />CFO City: <br /> <br />4O K(K,7N PR! YE <br /> <br />570ci(70A1 <br /> <br />1. Categories: <br />"Class A" (Direct Sales Only) $155 "Class B" (Direct & Indirect Sales) $310 <br />1111 <br />' Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT A LOWED. 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: prifainetir <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 />Water Source: <br />Please check what type of water source is being used at the CFO: <br />1/City Water LI Private Well* <br />*If a 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 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />()Q0C1f02.53 <br />2. Prohibited Items: Initial if you agree to abide by the following: <br />