Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name.„ <br />ev‘orAioreAdCeiliel•se s <br />CFO Physical Address CFO City <br />12(41 Ti-aL(er 6'eeti c4ccidon <br />Website (If applicAle): Telephone: <br />t:Ot bOc;lc_ Veochh 4br-tYll1etrO S Cc; on) (131S1-3voR• <br />Categories: <br />I=1 'Class K (Direct Sales Only) $186 c2.4 "Class B” (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: nig <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: A <br />Owner Name: <br />t 2,2025 <br />7 <br />.2 <br />te <br />CFO Zip: <br />95-ja, <br />\cAL-4%\\0 <br />\ • 22- zs <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 E Private Well* <br />f 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