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P2 os y S \-i ► `1 <br /> SAN JOAQUIN Environmental Health Department <br /> ---COUNTY-- <br /> `+;�:�,,_:` ('ireatness grows herr. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CIF Busi ess Nor ( Owner Name: Days <br /> V '�inckbreatS Cotil�les Trrznf�¢S 1OrG 1P .Rbir //d bw/ <br /> CFO Physical Address: -�(� CFO�Cit�: CFO Zip: <br /> J r4 11iNd 61'Y, jec rite j-tDC'Ayn IfScp0& <br /> Website(If applicable): leph e: <br /> OU 439-9608' <br /> 1. Categories: �/ <br /> F1 (� <br /> "Class A" (Direct Sales Only) $155 "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 hazardous and are NOT ALWED. 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: l t10dti �4 644iin NOV%ke s <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.sjcehd.com <br />