Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br />C OUN7Y <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: <br />(I:27 11 9 (_ CCCV V\_S N(UlAC 0 C <br />CFO Physical Address: CFO City: -) <br />-1c, \ <br /> <br />Date: <br />CEO Zip: <br />Clc 21 <br /> <br />Website (If applicable): Telephone: <br />(ctcz, -0233 <br />Categories: <br />27 "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: 1\1 - <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: c v_c_12e c s <br /> <br />tc (se-es, c e ) <br /> <br />stret tu 11-er <br />— - Po 4- et lit2 ,,,,ed.. <br />Attivutii Vkititif y q er/dee i//ei <br />efiAP1 P co.vukui, Po rK -49112-t23 <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 />Pleas check what type of water source is being used at the CFO: <br />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. Hazetton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />Sbc- Lfr