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SANAJOAQUIN <br />COUNTY— <br />Greotress grows here, <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: <br />Blee#:Jed biLd-orilerfokoil EACII CFO Physical Address: CF City: <br />iggil lutaaarittCL Waa kocKelOrol , Website (If applicable ): <br />(y7I 505 ,08'04- <br /> <br />Date: <br />f CFO Zip: <br />q5 Th3 <br /> <br />Categories: <br />0 "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: 3?9\ <br /> <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 />&Lucy 'ftecAda l rcok<lc-.3 exi?_0, Cu eccti.65- ,T3AD <br />UL,LA_KM, <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 />VZ.City Water 0 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 wvvw.sjcehd.com <br />osq s Ifl-