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..)SAN JOAQUIN <br />Greatness grows herc <br />Environmental Health Department <br />0 Li 0,7/ <br /> <br />COUNTY <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />0-e '61 I\ILess <br />CFO Physical Address <br />rbLil fIGQa0C1 LIN) <br />OwnVinleY\ SSCI \\OMV) <br />Date: <br /> 12 2-1 202:)D <br />CFO City: CFO Zip. st-gcAc-k-on <br />Website (If applicable): <br />i-k <br />Telephone: 20cill-k0)S03 <br /> <br />Categories: <br />Et "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: <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 />Food List: (411116110(106011-t, rted cutorakeA, <br />chocolat/. butrr(Acteea <br />OM CO\ CAA-C CAU CO OSou-151-e (hoc-old-17-J <br />cooPkci. <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 />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