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.4 1116 <br />T. sAN„JoAoulN f, <br />—COUNTY <br />04111;-11 c,:tx•," Greatness 9rows here. <br />H-0 -1 0kk-Ako <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />Sit VF 10 rct-t-oi‘i <br />Owner Name: <br />S7 4 Vi'n.P‘) 13,4sr <br />Date: / 7 4elett_ <br />CFO Physical Address: <br />EgiCK-S0 <br />CFO City: CFO Zip: <br />ci4L cic--ru kV (41- <br /> <br />Website (If applicable) i Telephone: <br /> <br />nif 5' <br />.", <br />C't <br />Categories: <br />V<Class A" (Direct Sales Only) $186 111 "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: <br />i-f0C,0 t- 6111-- C CC a it.i(Cc C c-L4--t-- <br />\cAe\- (\esed/L. konrve o\ddi es5- <br />k ,00 9 el - r\e€65 '‘r\ ed:ervA-s a, bvv-14er, <br />tO(A\ SJy." C crTy jc.k - <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 />12/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