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U� �, <br /> zl °� SA NPJ QAQ U I N Environmental Health Department <br /> COUNTY <br /> ctyir Greotn.ess grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> to <br /> CFO Physical Address: CFO City: CFO Zip: <br /> r t �- <br /> Website(if applicable): Telephone: <br /> 1. Categories: <br /> ® "Class A" (Direct 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 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: 11 11� t 1 <br /> (',bl)CD1Qk- emol 811nVnf, <br /> nllrnr�il nth ,� raa,..nairc� t]nlm lhr inri� afld calm nt� <br /> gj4wm� 1&4h e&�4 npn�4c�" r�lnr%% eXm- Vo,&r ir. ta)iAe dtcj mm". Cocom. Oeb.AEI' <br /> i`�}arr5l�mallpt.�— e;�nngt, Suri ��nrn.e�arcln, 1�hni Wa. , A,ex6t'LV_ <br /> tla�t�} nnrl n,r�1�,ca� �Dt, -�i�-f.rA�Ql�a1�,s0�, L]u+fL�a��9D te. <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). <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 /> S <br />