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P 5 `At 02_=TZ <br /> SAN J OA Q U I N Environmental Health Department <br /> COUNTY— <br /> C _ <br /> ,;,,,C,,;: Greatness groat Fr <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> Joycy Bakes Preetha Joycy Bellary Joseph 11/23/2022 <br /> CFO Physical Address:. CFO City: CFO Zip: <br /> 565 N castellina Terrace Mountain house 95391 <br /> Website(If applicable): Telephone: <br /> 6696009414 <br /> 1. Categories: <br /> "Class A" (Direct Sales Only)$186 ❑ "Class B" (Direct&Indirect Sales) $312 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: Pi <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 /> All types of cakes:example,Spong cake,Plump cake,Organic cake,Fondant cake, Honey cake, <br /> Cheese cake,Chocolate cake, Dry fruits pastry,Fruit cake, ice cream cake,Butter creame cake, <br /> Whipereame cake,Vanilla cake, Butter scotch cake.,Cuprakes,Celebration cake, <br /> Wedding cake,Event cake,Customized cake <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.sigov.org/EHD <br />