Laserfiche WebLink
SANAAQUIN <br />COUNTY — <br />Greatness grows here. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />A1i6e:5 Cikoco1a-t-e5 <br />CFO Physical Address: <br />(ci e evtk Ch <br /> <br />Ownpr Name: <br />/9- I ce TO h AS 0 <br />CFO City: <br />/la otecel <br />Date: <br /> <br />CFO Zip: <br />5— 337 <br />Website (If applicable): Telephone <br />2-0 4N CIg5 -11610 <br />1. Categories: <br />Er "Class A" (Direct Sales Only) $186 <br /> Lii "Class B" (Direct & Indirect Sales) $486 <br />2. 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: <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: frttl.".e-otrj'e-A 4-11-CCy fretz-e-dri e-d Ca ra kvv-el.5 <br />car a vvv ) ru,a_9 -e )cookc 2{O14Y1 i es ) q cc't-e co-vveS, <br />MOVI 4r5A 0,1 a. hos &rade ii-ito(41- <br />ChocolAi-e_ pp eA r-itrawk4i etag e ) 01'e-05, ri`oe kr isri'es pretzels; <br />marsk Link Ilow_5 <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 />Please check what type of water source is being used at the CFO: <br />City Water n 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 F 209 464-0138 I www.sjcehd.com