Laserfiche WebLink
• 0 5 c <br />SAN JOAQUIN Environmental Health Department <br /> <br />COUNTY — <br /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CEO Phy.5ical A <br />U \ILD A oLk_ aS <br />CFO siness Name: Owner Name: <br />CFO Zip: <br />) <br />1 CJA Lck--1-ArTC(N 933 <br />CFO City: <br />Website (If applicable): Telephone •ces, <br /> <br />C e ories: <br />"Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <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: Q5 0\ sv.)Qe-kS • c--SNA,-\ <br /> <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 />QskiL..._ 4 <br />(_cluiry\f (-54orty, <br />ksc..r.c_fsts,-vn c.,,LVN-4) <br />-sC : .\ e e <br />Product Labeling: <br />Attach two labels to this form for two of your CFO products (only one label is required if only one product is <br />made). <br />Water Source: <br />Pleye check what type of water source is being used at the CFO: <br />kr City Water 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.sjcehd.com <br />C of\C 1 b-1 93 tot 9-