Laserfiche WebLink
SAN JOAQUIN <br />U <br />094 51cow <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />.11(W. CO It+e, '1UrS'L <br /> <br />Owner Name: <br />V'Mcc ItA ,S3 <br />CFO City: <br />SAT (A/A-on <br />Telephone: c_Imyryz_ — L cj o <br /> <br />Date. _2024 <br /> <br />CFO Physical Address: <br />TP)7) Ark/011\74Dsr • <br /> <br />CFO Zip: <br />6r5 /2-11 <br /> <br />Website (If applicable): <br /> <br />Categories: <br />fk. "Class A" (Direct Sales Only) $186 <br /> <br />"Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the followin <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: <br />eikkcskurn SAA)cui (0-W-Lcc \).)\-\-tr\ i cal <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 El 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