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• <br />—COUNTY - <br />\ Greatness !jra!v.s <br />SAN JOAQUIN Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO BusinsNac4 cav„, <br />CFO POsi !Address: CFO City: <br />klArt one(2, e-c673 <br />Cla(a aY1.\TISn 4\cob at CEOz <br />ipqcj <br />Website (If applicable): Telephone. L.510 ' <br />1. Categories: <br />°Class A' (Direct Sales Only) $186 'Class LEV' (Direct & Indirect Sales) $312 <br /> <br />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 />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: <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 />lk City Water 0 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 <br />Date: 6 c90,0 <br />2. Prohibited Items: