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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0540146
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
10/7/2021 3:15:48 PM
Creation date
10/7/2021 3:14:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0540146
PE
1608
FACILITY_ID
FA0022955
FACILITY_NAME
STEVE'S KITCHEN
STREET_NUMBER
1928
STREET_NAME
ERICKSON
STREET_TYPE
CIR
City
STOCKTON
Zip
95206
CURRENT_STATUS
01
SITE_LOCATION
1928 ERICKSON CIR
QC Status
Approved
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SJGOV\jcastaneda
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EHD - Public
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09/20/2021 <br />I <br />09:32 2092346834 BASS FAMILYL <br />PAGE 01/02 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERIMITTING RENEWAL FORM <br />�FO Business Name: Owner Name: Da11 z <br />S�TEyr'S /l�ftcJ �S%'�V� SSS G� - <br />CFO Physical Address; , CFO City: CFO Zlp. <br />C/RcLr- ._S %UC)CrOAJ %s 2 a6 <br />Website(if applicable): Telephone' G <br />(14) 20 <br />I. cage n® <br />ries'. <br />"Class (Direct Sales Only) $155 I] ,Class B" (Direct & Indirect Sales) $310 <br />t. Prohibited Items' Iii 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-bome 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 <br />Vic% /GAll� .fir/' w�"rtJALJvv>' GOQ2 ic=y <br />4. Product Labeling: <br />Attach two labels to this form for two of your CI"O products (only one label is required if only one product is <br />made). <br />5. wator Source: <br />Please check what We of water source is bein<I used at the CFO: <br />[City Water ❑ Private Well" <br />`if a private well, attach all updated water samp a 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 />.� r k <br />
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