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SANPJOAQUIN p <br /> Environmental Health Department <br /> "" —COUNTY <br /> jl� Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business me' I" I area Owner Name: Date: <br /> CFO Physical Addref slslFO City: 1 1 CFO Zip: <br /> 9 /�• �lc,�ch� ns S 915aM <br /> Website(If applica le)' Telephone: <br /> 'RAf`�fir�p- <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155. ".Class B" (Direct & Indirect Sales) $310 /y <br /> 2. Prohibited Items: Initial if you agree to abide by the following: li <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: - MADE IN A HOME KITCHEN <br /> Permit#PT0024031 <br /> Provide a list of all products you are preparing. If prepa BAM Treats Mild k4 <br /> ingredients (attach separate page if needed). Lodi, CA 95240 <br /> Food List: <br /> 209-482-7846 www.bamtreats.com <br /> Sugar, Milk, Chocolate, Cocoa Butter, — <br /> �� ick Milk Fat, Lecithin (Soy), Natural Flavor <br /> J ` MRde &XetkSCveLlj WLtk gtue nCauuoMrI <br /> Rtw,.ov,d5 _ <br /> A�,dp... � ,\11 f!�libiLi, jsos. 7 , <br /> ,r <br /> >' v <br /> 4. Product Labeling: <br /> Attach two labels to this form for two of your CFO products uct is <br /> made). %../i/lll <br /> HOMEMAfJE�"TET TOFFEE <br /> h(Nil <br /> Contams: <br /> 5. Water Source: Almonds,Butter,Chocolate,&Sugar <br /> Please check what type of water source is being used at the cru: - <br /> 0 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> _e„ <br />