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r <br />SAK JQAQUIN a <br />Environmental Health Department <br />C` —COUNTY— <br />\,tr���a P' Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name:p�, Owner Name: Date: <br />?wl I Q.1 Q01ce L7 uaC a)tG TOCCC)i1 C1/2/22 <br />CFO Physical Address: FO City: CFO Zip: <br />1620D k) Hur)+u Cj1. StoC txn g52o u <br />Website (If applicable): Telephone: <br />IY�P ItngcblCt.cam XXi 4oj.OF2$ <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: UT <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-bome 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: uqj_ )%,2s, blcndles. G�cCa)c_�c g i-tA-' cood-.a , m'1C("e� <br />cwcteb, c -NToO ccotiieb., Ld iWerdo(30le ccciy)te Dc3anu+ butlfr <br />CI)P Cb0Yiea, R -yQ_Ai Cone- eco. Ohocoja�e <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.sjgov.org/EHD <br />