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SAN.,JOAQUIN Environmental Health Department <br /> L-'rLy —COUNTY— <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Own, Name, , Date: <br /> TSL N�C; Wt4u c�f_SCFO physical <br /> �' <br /> Kl G h l���Address: CFO City;," nd n CFO Zip: <br /> J-� � L <br /> Website(if applicable): Teleph n : 1J ��I�� fly <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only)$186 "Class B" (Direct& Indirect Sales)$312 { pp <br /> 2. Prohibited Items: Initial if you agree to abide by the following: �/ V <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: �` C <br /> J , Maw <br /> 4. Product Labeling: <br /> Attach one label 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 /> lease 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 />