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SAN JOAQUIN <br /> <br />Environmental Healtilpepartment <br />--COUNTY-- <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: Date: <br />FreezyFrostyLLC <br /> Patricia Vermilus 11/17/2024 <br />CFO Physical Address: CFO City: CFO Zip: <br />79 N Menlo Park St., Mountain House CA <br /> <br />95391 <br />Website (If applicable): Telephone: <br />209-321-1817 <br />Categories: <br />ad "Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: PV <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 />2Letym <br />rl ./1/T" 'EC61/0 <br />NOV 2 0 2024 <br />SAN Jog <br /> EA/V/RoN/viE-N7-AL <br /> r <br />riE.ALTH DE pAiR rivzNT <br />Food List: <br />Freeze Dried Candy Freeze Dried Vegetables Freeze Dried Fruit <br />Italian Cookies <br />Italian Breads <br />French Cookies <br />French Bread Chocolates <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 LII 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 Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />IPP OSLI1 2