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SAN jOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />T CF Business Name: <br />Ckf1:3CreekbLII.1 <br />CFO Physical Address: . <br />,3,CD ilc -te_ St. <br />Website (If applicable): <br />Owner Name: <br />/ J:4111Cri ti a <br />CFO City: <br />SIVa-1-0'n <br />Telephone: <br />Date; <br />Lk" C)/f_)- L-/ <br />CFO Zip: <br />615-C). 0 <br />4415--qs-eis- <br />Categories: <br />I1113 "Class A" (Direct Sales Only) $186 LII "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: I <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: L. ( f -0M( cs ct <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 />tf)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).