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SAN JOAQUIN <br /> Environmental Health Department <br />COUNTY <br />L Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />y‘ CFO Business Name: Owner Name: <br />CFO Physical Aeold-?ess: CFO City: <br />(2) CO?:'•9•-, V\ --V OD\C <br />Website (If applicable): Telephone: <br />Date: <br />/ <br />CFO Zip: <br />CA q55-71 <br /> <br />)\,29-094-1,3 <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $312 <br />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 />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 />(2,00 <br /> J.m)/ (11\e„. <br />OC-Cr--- ra.:\ <br />130-r (NM-A- cr';\ 41/4A 6SCAA.C1,2‘a-A. <br />AY C/ • Q. I <br />p (0j (.5.0 S--e1 1. <br />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 />Water Source: <br />Please check what type of water source is being used at the CFO: <br />skcj City Water El Private Well" <br />*If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />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 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD