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COMPLIANCE INFO_2022
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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ELLIOTT
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23216
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1600 - Food Program
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PR0546753
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
6/23/2022 1:57:52 PM
Creation date
6/23/2022 1:55:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0546753
PE
1608
FACILITY_ID
FA0026501
FACILITY_NAME
ELLIOTT ROAD BARN
STREET_NUMBER
23216
Direction
N
STREET_NAME
ELLIOTT
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
23216 N ELLIOTT RD
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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;- SAN tf QQQUIN, Environmental Health Department <br />My � <br />Greatness grpa-s Here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Business Nam lhmer N e: Date: <br />10+1- 4tx1d `r� �u(�_�2 <br />CFO Physical Address: CFO City: CFO Zip: <br />Website (If applicable): Telephone: <br />1. Categories: <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 follovvin_ <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NO 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: �rI i l P I � C-11 V1 / V-0) J <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 mw.,.sjcehd.cortr ' I <br />
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