Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> ,c„�,.q ureotness grows her, <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> Smit Farms Michelle Patwell 1/15/2021 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 12236 N.Clements Rd Linden 95236 <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> V "Class N' (Direct Sales Only)$155 ❑ "Class B" (Direct& Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: MP <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: Honey,Jams,Apple Preserves(sauce), Dried Fruit <br /> JAM:Blueberries,Sugar, Pectin <br /> Apple Preserves:Apples <br /> Dried Fruit:Apricots,Peach,Plum,sulfer dioxide <br /> Dried Cherries:Cherries and sunflower oil <br /> 4. 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 /> 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.sicehd.com <br />