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Environmental Health Department <br /> MAHN <br /> ----CC)L] NTY---- <br /> ` = / <br /> '� ~^ Greotncu grows 6eru <br /> -- <br /> COTTAGE ����� OPERATIONS M���� <br /> ..�� o nv�~�~~ FOOD ~~" ~~"~"�^ ^~~^~~~ (CFO) <br /> ��^�U Uo���'�������o� ��N� ���� <br /> ..~�~,"~° " .~... .~~.,~. ~~.~.~.. ' - ---- RENEWAL FUKM <br /> CFO Business-Name: Owner-Name: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1151 Mokell&mvie- L-ocl`t CA <br /> Website(if applicable): Telephone: <br /> '' <br /> "Class A" (Direct Sales Only) $18G [l "Class E" (Direct& Indirect Sales)$488 <br /> _. Initial-- if you ~ by the following <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT �J�,����U�. 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 offood-borne illness. , <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 pageffneede0). <br /> " <br /> Food List: <br /> RECEIVED <br /> tv----------ENVIRONMETM-L-TWA <br /> LT H <br /> DEPAUNIENT <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 /> —^ <br /> Water Source: <br /> Please check what type ofwater source is being used at the CFO: <br /> City Water [] Private Well* <br /> private wen, attach an updated waiter sample results(including quartedybaclefia and Nitrate results.) <br /> 6, (6-H-&A�� � <br /> /#toohfoodhond|eron��ootionforownorandaaohind��duo|��utwere not submitted with initial application <br /> (including family members and/or employees). <br /> 1868 E. Hazelton Avenue i Stookton. California 95205 1 T 209468'3420 1 F 209 464-0138 1 vmxmv.sjnohd.oum <br />