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Y7 5"/ Z <br />SAN JOAQUIN <br /> <br />Environmental Health Department co, NTY— <br />i3w <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name Owner Name, Date <br />SWEET Dempcso <br /> <br />NoRMA -FERREIRA zli-F 12025 <br />CFO Physical Address- CFO City: CFO Zip: <br />PELTIER RD <br /> <br />ACM\41°0 9522D <br />Website (If applicable): Telephone: <br />(2.0 01) Len - 251 <br /> <br />Categories: <br />E "Class A" (Direct Sales Only) $186 r] "Class B" (Direct & Indirect Sales) $486 <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. 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 /> <br />Food List: DTi.YZtES, 154NDT CAKES, CAKESICLZ, CAKE Tlevl-ffLES, <br /> <br />1,11)(1 CA V\I r piNG CODKIS, COOKIES oituo m 2-m, MK() LATE COP, <br />TuNfern, tAINT (tta img,ms, °RED, S'NOS), BROrotiEs, FiAml9 p1•1 <br />Mtn <br /> <br />LOP, Ctrl)(JOU\T coreD olze-05/ 19 R_TzELS <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 />"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 I F 209 464-0138 I www.sjcehd.com