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r 10.apa `OG 1F SAN sJOAQUINp <br /> Environmental Health Department <br /> COU NTY <br /> GrentnQss grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REG ISTRATIONIPERMITTING RENEWAL FORM <br /> CM Bu mess Name: Owner Name: pate: 12-2;. <br /> CFO Physical Address: CFO City: CFO Zip/ <br /> Website(If applicable): Telephone: n <br /> 1. Categories: <br /> F "Class A" (Direct Sales Oniy) $155 ❑ "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-pctentially 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 /> ` � 1 <br /> O k 'c— <br /> 4. Product Labelinq: <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). / J� <br /> 5. Water Source: <br /> Please check what type of wafer source is being used at the CFO: <br /> P 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 � Stockton, California 95205 j T 209 468-3420 1 F 209 4640138 � www.sjcehd.com <br />