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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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PELTIER
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1600 - Food Program
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PR0548849
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
1/16/2024 11:09:43 AM
Creation date
1/16/2024 11:09:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0548849
PE
1608
FACILITY_ID
FA0027993
FACILITY_NAME
JACALYN SOUTHER
STREET_NUMBER
9355
Direction
E
STREET_NAME
PELTIER
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
9355 E PELTIER RD
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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- SAN JOAQUIN Environmental Health Department <br />--- -COUNTY— <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />SOutki2r <br />CFO PhysicalAddress: CFO City: <br />3 SS- e-Pe--( r <br />Website (If applicable): Telephone: <br />'3(0 ()c? 6 ,3 I-g <br />Date: <br />t 21/4/2.3 <br />CFO Zip: <br />4"-C6474-10-e) Q 6757a 2- <br />1. Categories: <br />RK"Class A" (Direct Sales Only) $186 <br />sr&u-/-/a,r a ) <br />E "Class B" (Direct & Indirect Sales) $312 ktif at/ <br />e C-dlitek <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 foods <br />that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food-borne illness. <br />"Class A" Self Certification Checklist: <br />r/6-hecklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Li <br />0 <br />LI <br />LI <br />0 <br />0 <br />0 <br />0 <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />0 <br />0 <br />0 <br />1=1 <br />CI <br />0 <br />0 <br />0 <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />0 Honey <br />0 Mustard <br />0 Dried Grain Mixes <br />0 Flat Icing <br />LI Pizzeles <br />07-Nut Mixes/Nut <br />Butters <br />0 Trail Mix/ Dried Fruit <br />Salted LI Caramel/Fudge <br />Popcorn/ LI Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />Ground LI Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />LI Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd
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