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SAN JOAQUIN Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATIONIPERMITTING RENEWAL FORM <br />CFO <br />CFO Physical Address: CFO City: <br />CFO Zip'. <br />Website (If applicable): Telephone: <br />1. Categories: <br />IX "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 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. <br />ingredients (attach separate page if needed). <br />Food List: <br />If preparing jams, jellies, or fruit butters include a list of <br />4. Product Labeling: <br />CFO products (only one label is required if only one product is <br />Attach two labels to this form for two of your <br />made). <br />5. water Source: <br />Please check what type of water source is being used at the PriCFO: <br />Well• <br />J City Water <br />"If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />Food Processor Course: <br />Arinch food handler certification for owner and each individual that were not submitted with initial application <br />(including family members and/or employees). 8 3,1201 F 209 464-0138 1 www.sjcehd.com <br />1 fifit3 F. Nnaelion Avenue I Stockton, California 95205 1 T •O <br />1 <br />A <br />