Laserfiche WebLink
SAN J O A Q U I N Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> Pyramids Desserts Mohamed AbouSamaha 4/30/2023 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1721 Duncan Rd. Tracy 95376 <br /> Website(if applicable): Telephone: <br /> (443) 220-4864 <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: MA <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 /> Will be making middle eastern desserts .. Mainly things such as unafa <br /> and Baklava The desserts mainly consists of flour, suqar, salt, v't. starcl <br /> Vanilla, Butter and Nuts <br /> 4. Product Labeling: <br /> Attach one label to this form for one 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 /> Hazelton Avenue I Stockton. 95205 T 209 438-3420 ;. F 213964-0138 1 wwiv.s gov.o-rq EHD <br />