Laserfiche WebLink
P 2 C) <s 2 <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Businessams:61 1 Owner Na Date:AY Q In� <br /> (� <br /> CFO Physical A ress: 0 CFO Cid CFO Zip: Y 10 <br /> 9P3_7 <br /> Website(If applicable): Telephone: -7l <br /> 1. Cat�ories: <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 followin94 <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: /� <br /> 2_ tl 'c4n `MZ—P-& (n1- Ca(G,l�yk mcun - fNl _�-6rtm cS — <br /> �_.�1.oC��a� CDJQ�C21�1 t�lw-� �� <br /> �= C - Q.,�o•, r � Jam,-, 221 <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 />