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SAW,JOAQUIN <br />COUNTN/ <br />Greatness grows hcrc <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Bu mess Nam?: <br />CFO Physical Address: <br />3 22c Lcuick 01A+D e ., <br /> <br />Owner Narri?: <br />hnneil ka_fris <br />CFO City: <br />4-0 <br />Telephone: <br />2-9 -59 S3` <br /> <br />Date: <br />- I <br /> <br />CFO Zip: <br />CA t 9 5-2-01 <br /> <br />Website (If applicable): <br /> <br />Categories: <br />"Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: 41-1. <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 />6tuckte , <br />occf-Tret( <br />citoco(Q4e <br />letA-co-r_ Cot, L.--; es /0 at VI (A.4- bwifc r Coo la es i <br />yIv coott-jes cw[rrt-latl G./ct(hcL4- Cc c - <br />cr„( coo e5 ( un --fr- Re etto c 7 (i c ki p <br /> <br />Cco <br /> <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 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 <br />PR0SLILI2Lico