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- . COUNTY <br />SAN JOAQUIN Environmental Health Departmi <br />CEO <br />MAMAS <br />. Greatness ;:irne,-s hP:-.E•• <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br /> <br />Business Name: Owner Name: Date: <br /> <br />TOUCH JULIE WUTZKE 4-23-24 <br />CFO <br />21 <br />Physical Address: CFO City: CFO Zip: <br />00 N KENNEFICK RD ACAMPO, CA 95220 <br />W <br />m. <br />bsite (If applicable): Telephone: <br />.m.a.s.t.o.u.c.h 209-327-0548 <br /> Cate• ories: <br />RI <br /> <br />"Class A" (Direct Sales Only) $186 E "Class B" (Direct & Indirect Sales) $312 <br />JW <br />Prohibited Items: Initial if you agree to abide by the following: <br /> <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br />foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Oper <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that coulc <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 />SUGAR COOKIES <br />Product Labeling: <br />Attach one label to this form for one 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 />0 City Water 1Z Private Well* <br />*If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br /> <br /> <br />nt <br />Only <br />ation. <br />be a <br />6. 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 />E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD 1868