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° SANAUAQUIN Environmental Heath Department <br /> a � COUNTY . <br /> E <br /> Greatness grows Dere. <br /> SEP 2 5 2020 <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORIMvlRONMEN l - <br /> PERMIT. <br /> CFO Business Nam Owner N e: Date: <br /> I�� 1SCruo� � A ct-Ac' 2-D)20 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> '204D 60[CtW eue Wm Ma..v" <br /> Website(if applicable): J 4elephone: <br /> Dcl- R1c5 -( �� <br /> 1. Categories: <br /> "Class A" (Dlrect Sales Only) $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-potentially hazardous" are approved for preparaticn 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: L>Coe_OCL !rLf CwA Gt. <br /> rel Yl iyl ear i n q V-e, iQt�c,�c�f'� <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 /> made). <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 /> 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />