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SAN JOAQUIN <br />---COUNTY— <br />Greatness grows here. <br />PROS'ALIOH <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />CLA.-0eA. CLoAfeeli,r) s <br />CFO Physical Address: <br />K351 C_rut er, SA-. <br />Owner Name: Date: <br />\ICM ESSCkSt,,\5 I 212_14. <br />CFO City: CFO Zip: <br />SiocIckv-‘ cAS2_09 <br />Website (If applicable): Telephone: <br />ScA.AS-Vow‘cn -Pkak 0 ins. ( kin (Z01)59f',-41-1(4)1 <br />Categories: <br />.g "Class A" (Direct Sales Only) $186 LI "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: \TC. <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\-voco\okAe_ ) kx*Ak_C-\/\oc.0.1c0-1. Oc,u,1 Cithws, V-eilAkAk- <br />Ccuk r Sirv\eres Zrtn.A., e.‘.,Z\o‘Ack;e. I Car vv.ek; \-ks i OarNer.,1 CYf& Pi <br />. VdIes.zro,N.eQ\ Ccor,:kes RECEIVED <br /> <br />JAN 0 4 2024 <br />ENVIRONMENTAL HEALTH <br />Product Labeling: DEPARTNIENT <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 LI 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 I F 209 464-0138 I www.sjcehd.com