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SAN3JOAQUIN <br /> <br />Environmental Health Department <br />COUNT <br />rtS-4.* <br /> Greatness vows <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: Date: . <br />cr1 LA' S6C4 ti-}(44::A rs )3t4 <br />CFO Physical Address: CFO City: CFO Zip: <br />1)35 e'A-hnr0 L. .1\1\anN.. 4: cA <br />Website (If applicable): Telephone: <br />0c9 s1 (o-1 <br />Categories: <br />-4 "Class A" (Direct Sales Only) $186 ID "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: vi\- <br /> <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 /> <br />0,44;11 o. C &- Su.c)o-r e s <br />cLoLa L't ,n , CX4Lt-ONI ci\f\OC4Lok-e_ tOLtVVeAr C/N cA1ev‘ <br />Ck1N (.Ckti\ . <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 />Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water El Private Weir <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 applicatim <br />(inciuciina family mempers anaror r. <br />1868 E. Hazelton Avenue I Stockton, California 96205 I T 209 468-3420 I F 209 464-0138 I .wwwajgov,org/EHO <br />Food List: C)1\0Cok..cat