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SAN JOAQUIN Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTING RENEWAL FORM r + <br /> �Y1fCP+�/i am <br /> �rIIrlfell `�OROf� 1�i wfl <br /> J <br /> 45� CF <br /> WeOe:N 1h aDdKetM}. TgMmr n(y''�- � /5`/J <br /> 1. C to O—l7--Class A' !D:rc.z Saes Orly)S155 'Class 8"i7i>eG 8 Irtd,re Sorest 5310 <br /> 2. Prohibited Itpms: Initial If you agree to abide by the foltowingik_ <br /> Foods contaoing cream,custard,a meat fillings are potentially hazardous and are NOT ALLOWED On y <br /> t-ods that are deuned as'non-potentus-'y hazardous'are approved rpr preparabcn by a Cmage Food Opera'eon <br /> Tri Bods inctude Items that do not require re"raWn to keep them sale from baclehal growVh that coin be a <br /> mum of food-bonne Illness <br /> I Products: <br /> Provide a Inst of all products you we preparing. It preparing jams-Jolles.of h1111 butters Incudo a IIsi e' <br /> iruiredierits(attach separate page if needed, <br /> Food Ls: <br /> 4. Product Labeftna: <br /> Aha-h two labels�^lis form for two o`,your CFO products!only one 1aW s req�rred,f only ane prrld:,Gt 11 <br /> rnwe). <br /> 5. Water Source: <br /> R" chMA what type of nater S*Vrce 3bem used a!:he CFC <br /> City Waic '"l Pnala We!1' <br /> -if a prnrate swell, abacri ay uodaled warm sample•ssuft(lracluding quarterly bacterin and NNa a results <br /> 8. Food Procvsaor Course: <br /> Attach food handler cerofcatrn for owner and each lnarvdual that were not suomittad with Indbal application <br /> (1nchAtng fan*mernbers anelor amployees). <br /> 1888 E Haze�Wrl Avenue; Sixron-C2iifl, iia 952051 T 209469-34201 F 279 LU-0138 I www slce*.d.wm <br /> S <br />