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SANAOAQUIN <br />COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />,CF0 Busipess Name: Owner Name: Date: <br />VOW' Mee th Vr i6A10"A OrAidneelAitt 3116111 <br />CFO Physical Address: CFO City: CFO Zip. <br />?)2rol <br /> <br />pt (Non Ai-e <br />Welpite (If applicable): Telephone <br />C <br />:(2zci\ .--2.77ii .(004. I rivar 45 Po maTh coin <br />Categories,: <br />"Class /k" (Direct Sales .5155 <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 />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: oth-tes ecfrri Avg._ <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 0 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 />1668 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />0 "Class B" (Direct & Indirect Sales) $310