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�vTo\ <br />is SAN: ON Environmental Health Department <br />"-� it?i —COUNTY— Lf�S����V�D <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) SEP 14 2022 <br />REGISTRATION/PERMITTING RENEWAL FORI%NVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />CFO Business Name: <br />Owner Name: <br />Z <br />CFO Physical Address: CFO City: CFO Zip: <br />5'1(0 5cho,5;�Re- O`C_ L ohxt 15296 PAYMENT <br />Website (If applicable): Telephone: "I . " E I V E D <br />I31 A (zol) 251-770` <br />1. Categories: <br />X "Class A" (Direct Sales Only) $186 <br />2. Prohibited Items: <br />SEP 14 2022 <br />SAN JOAQUIN COUNTY <br />❑ "Class B" (Direct & Indirect Sales) $31aHEALTIRO ENTAL T <br />Initial if you agree to abide by the following: A - k - <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 />0 - <br />S owy_- �m \�em9 w��� CG -n\&\ N dY Ned �'4N v- his . R\g} <br />4. Product Labeling: <br />Attach <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.sjgov.org/EHD <br />