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SAN JOAQUIN <br />COUN —Y <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CACY%S e CCI <br />CFC143\ ucmess Own.pr: Npme: <br />\\( k(Ing relqf <br />CFO Physical Address: CFO City: <br />237:5 O en Nve., Sfibcit-N\ <br />Website (If applicablet). o Telephone: <br />\r4 101 •• 016x ‘s coo\ c-kt co ()Ty, 2061-1-111- '5 39 -1 <br />Categories: <br /> <br />"Class A" (Direct Sales Only) $186 D "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: MA <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 />• <br />Food List: v ov‘ e , cks cvic3A{ CA7 01c-te3 cq kzA <br /> <br />o• • <br />CAA ( CAV•tfl r \r-cy,:jc-1\ ic 10,144-ei-c r-co I fre.41 ck rr, Cl c(i re„ns <br />(-1°,(-)n CA rct ()P. Vb \\ <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 />Kj City Water D 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 1 209 468-3420 I F 209 464-0138 I www.sjcehd.com