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Environmental Health Department <br /> SANAOAQUIN <br /> COUNTY <br /> .Yrs <br /> 4��Q Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTING RENEWAL FORM <br /> CFO Business Name: <br /> Owner Name: Date. <br /> 3d fa <br /> a y rr 6u1� <br /> CFO City: CFO 71p: <br /> CFO Physical Address: a <br /> Website(if applicable)' Telephone: <br /> M <br /> 1. Categories: <br /> ❑ 'Class A"(Direct Sales Only)$155 1A, "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 hazardti nnb as Cg OT ALLOWED. <br /> ra�pera0iion <br /> foods that are defined as'non-potentially hazardous"are approved for prep Y <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of flood-borne illness. <br /> 3. Products: <br /> Provide a fist 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: <br /> tA �tMinld i47 COA CO Ale <br /> Coop G' O �ddJc[cts <br /> Y <br /> 4. Product Labelin : <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 handier certification for owner and each individual that were not submitted with initial application <br /> (including family members and/or employees). <br /> 1g68 E.HazeWn Avenue I Stockton, California 95205 T 209 46&34201 F 209 46"138 1 www.sjcehd.com <br />