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PR -ki -9-17 <br />SANsJOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br /> <br />. . <br /> Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Busines Nerpe: clOwner Name: Date: <br /> <br />L.% ti-tt 1 15 ND t 7,02-0 <br />CFO Physical Address: CFO City: CFO Zip: <br />I 3CAD QuA4-42- (.32A.j4 but-41--oe c;A- <br />Website (If applicable): Telephone: <br />tid GOLO C-61_,terS (114i4â€ĒC" I - COO') ea-pdf-i'l <br />Aotlic-ite,„„... <br />1. Categories: <br />"Class A" (Direct Sales Only) $155 Li "Class B" (Direct & Indirect Sales) $310 <br />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 ALL IWED. 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 />Li <br />cause of food-bo ne illness. <br />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). -5",-“-cfa t <br />eao,li 4 &) <br />4-0-601ift-te), <br />Food List: izzkil-fga <br />p\AzI ""17,4rik._,` y <br />vA I 4.244DS <br />ra4-eleq <br />5-0,iro:m 5.tt4" <br /> <br />1,-A4 so wy <br />LI-titAt4 Le.../...4 <br />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 />Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water El Private Well* <br />*If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />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. Hazejion Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com