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prZ os3 1 s3q <br />r,SAN JOADIN <br />REGISTRATION/PERMITTING RENEWALI-UKM <br />CFO Business Name: Owner Name: Date: <br />CFO Physical Address: CFO City: " CFO Zip: <br />\C'.'R< M r'.c �:U P1 Vv\aA,e CG_ CVS U�J�-_ <br />Website (If applicable), Telephone: <br />UCS 1C OHI <br />1. Categories: <br />2' "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: <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 />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 T 209 468-342.0 1 F 209 464-0138 1 www.sjgov.org/EHD <br />�►�a53��3L1 <br />