Laserfiche WebLink
y SAN JOAQUIN COUNT Y t•-•' <br />Circe tn es s cirws her. <br />PQ-o s\-t -+ 213 <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />Queen B's Herbal Teas and More <br />CFO Physical Address: <br />9321 Pioneer Circle <br />Webs he (If applicable): www.queenbherbals.com <br />1. Cate ories: <br />Owner Name. <br />Ursula Kemp-Paden <br />Date: <br />8/20/2024 <br /> <br />CFO City <br />Stockton <br />CFO Zip: <br />95212 <br /> <br />Telephone: <br /> <br />800-523-1905 <br /> <br />2-00\ • 22_1- Sobb <br /> <br />1-31 "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: UKP <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 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: Herbal Tea Blends and Herbal Seasonings <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 />Eg 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. Hazeiton Avenue I Stockton, California 95205 I 1 209 468-34201 F 209 464-0138 www.sjcehd.com