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eV-0 s <br />SANJOAQUIN <br />COUNTY <br />Greatness grow , f, <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Iliainess Name: Tr o p uLl Stvte_5 °la Mitt- CaS+;[(6 <br />CFO Physical Address. <br />431,0 ed-uhu-tv-cbv-.) <br />Date: 411:)12,q <br />CFO Zip: <br />616" <br />$50 City: <br />hrac <br />Website (If applicable): Telephone. <br />JO — (12 6) 9-Obti <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following-JAM- <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 />CJ1DcD1,94e. MacrAdavvoL Niuds <br />eilDCOLC2-te. \I-0/7-CD AimmoLs, shr-ow.J9-exries, <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 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 F 209 464-0138 www.sjcehd.com