Laserfiche WebLink
SAN )O A O U I N Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTING RENEWAL FORM <br /> nC O Busi N,atnr Oamri N,j(Tll• Date I <br /> `_CkIU _ Ca )1,Otna. T) QYII.� S <br /> FO Phys aA Aitdr•s5 CFO City �1 CFO Zip r�t <br /> '�� <br /> Wobs�t If applicable) Telep�v �cam – `� <br /> 1.. Categories: <br /> L]dJ -Class A'(Direct Sales Only)$186 ❑ 'Class 13'(Direct&Indirect Sales)$486 <br /> 2. 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 AL ED 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 front bacterial growth that could be a <br /> cause of food-borne illness. <br /> 3. 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 <br /> �w <br /> 4. Product Labelinq: <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 /> 5. Water Source: {/ lV) �d <br /> Please check what type of water source is being used at the CFO: <br /> City Water El Private Well' \RCUA <br /> 'If a private well, attach all updated water sample results(including quarterly,bacteria and Nitrate results.) <br /> 6. 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). �-- H–C e x n � (-e S Z— i N - Z y <br /> 1868 E Hazelton Avenue I Stockton. California 95205 1 T 2\09,468-3420 1 F 2x09 464-0138 1 www sicehd rom <br /> S <br />