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Environmental Health Department <br /> rT= SANAOAUUIN <br /> _COuNTY— <br /> ' g..-s hrre <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL-FORM <br /> Date: <br /> pHy Name: <br /> r�OFOCFO ZI. <br /> CFO CRY. <br /> CFO PhYS� <br /> TelcAwne. <br /> wemua ptrpoaeNe>: <br /> 1. Categories: -Gass a-(Direct 8,Indirect Sales)$310 <br /> 'Gass A-(Direct Sales only)$155 <br /> 2. Prohibiters initial If you agree to abide rd the foland am <br /> NO:_SLO— <br /> OWED- <br /> Foods containing Imam,wstard, <br /> or meat fillings are potentially he zardoruation by a Collage Food operation. <br /> foods that are defined as-non-potentially hazardous'are approved for preps <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-bome illness. <br /> 3. Products: <br /> Provide a fist of an products you are preparing. If preparing jams,jellies,or fruit butters include a list of <br /> ingredients(attach sapamte page if needed). <br /> Food List <br /> CA <br /> s <br /> 4. Product Labeling: <br /> Attach two labels to this form for two of your CFO products(only one label is required it 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 /> Olt!�ity 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 />