Laserfiche WebLink
SAN_10AQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows herr <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />C O Business Name: Owner N Date: <br />Irlrt�e.(S �a "ice Suie� I6w fiX64(d R1.2R17,Z <br />CFO Physical Address: CFO�Clb: I' CFO Zip: /r <br />390yiiaUe_ Ck cc e, w� g5zo i <br />mebsite iLYY.t(if <br />t, I,Iilcable): U ewci, � Sli 1 co(y) <br />.2c)9,5q83, rsrra <br />1. Categories: / <br />El"Class A" (Direct Sales Only) $186 V "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 />Pleas heck 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 />