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SKJOAOUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness groins here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Name: Date: <br /> Sweet Demo N o rmol :rr e irol I I n 1 uz 3 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> IW25 E VOU r IA ACAmpo 85220 <br /> Website(if applicable): Telephone: q� d <br /> 1. Categories: <br /> y "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: N� <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: �j�nVl IVIS I VU SGS i M� ��i��� Chi/rsi <br /> NVA(lon 1[041 r ; cooly S C Oren MIM, Relf'se's pvtQs, <br /> C ho co W Ch 1 p, w 011 Y1 Ut GNU 10W C/h i P , m I nt c h i f9, _Nr&f_h <br /> brownW t ?AM n WOO Loot4l cho(,ulr is covered oneos / <br /> 4. Product Labelinq: <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 /> Please check what type of water source is being used at the CFO: <br /> ❑ City Water [Q 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 />