Laserfiche WebLink
�P_o 5-� --s 1:�k, <br />SAN J O A O U I N Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name <br />Plno-ioe6N wh <br />Oanor Name <br />1+�'►et U rrr►�prnc�t.t <br />Date <br />D3 � �?? - <br />CF O Phy%iral Address <br />CFO City. <br />CFO Zip: <br />ee "wMIT Atilt <br />Utflwle f%A <br />as7np <br />Website (if applicable) <br />TolepWno <br />1. Categories: <br />V] "Class A" (Direct Sales Only) $155 <br />2. Prohibited Items: <br />❑ 'Class B" (Direct 8 Indirect Sales) $310 <br />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. If preparing jams, jellies, or fruit butters include a list of <br />ingredients (attach separate page if needed). <br />Food List: <br />Plmn ri�4 L I wt/UG W <br />Kru R t QAU kV- i NU14T 101IL M Wf kPV tCL <br />4. Product Labeling: <br />Attach two labels to this form for two of your CFO products (only one label is required ii 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 />[X 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 />40&20 C U^v^14^n A,.."w..n 1 00-1,4— /`."IUn...i.. nr0nr 1 T Inn ACO OA' A I C 1t n ACA /NOO I ....... ,..... kA ,,...., 15 <br />