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I pp - - �'(z- 5 3 39.5 ► 5'� _ <br />r;':'l <br />I <br />;:Crl JfrfJ-,t , lit Jf-3 Qsr"i S;A'', C;r rb'.`r<•.'�� l <br />i <br />t <br />,. c'aeerngries_ <br />j.�' r'I s: a ,1).n;c!ogles U�lyl S', S� I lasstl d1'.rrct `C lyd'rer; Sa es, .?1C <br />. f. <br />�. Prohibited Items: Initial if you agree to abide by the following: -I--- <br />Foods <br />I—_:Foods wntaining cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED O^.; <br />!suds that are defined as non -potentially hazardous are approved for preparation by a Cottage Food Ope-w v^ <br />I nese foods include ,tems that do not require refrigeration to keep them safe from bacterial growth that -oatd ce a <br />cause of food-bume ,Mess. <br />3. Products: ` <br />Provide a list of all products you are preparing. If preparing tams. jellies or fruit butters include a !ist of _ I <br />ingredients (attach separate page if needed). - <br />�� t <br />Food List liC1`Zl�—� Z-�� ��1f��\ __ - � ✓ A 'y ` <br />57 <br />s,&'S4454 <br />-,MDdvt,. in Rrn^ r ry,,f^, <br />cQaae �4 G e�zr2 <br />ftkf <br />So <br />4. Product Labeling: <br />o: r s) av7 <br />�j Attach two labels to this form for MO Of your CFO p�,,, g,. -„e label is required if only u,,.. _ __..., is Z, i <br />made). � Q <br />5. Water Source: /�✓ ���I1 <br />Please check what type of water source is being used at the CFO./ <br />❑ City Water n Private,�Yell' <br />i+•' 'If a private well, attach all updated water sample results icluding quaiteny bacte•'a and Nitrate results,) <br />6. Food Processor Course: <br />r Attach food handler certification for owner and each individual that were riot submitted with initia! application <br />(including family members and/or employees). <br />='r ' <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 j tvmw. sjcehd.com <br />—%, I <br />