Laserfiche WebLink
<br />St g 144 (9 2./ 2-‘/ <br /> <br />PR OT 11;v8 I I <br />64 Lf t, 35-32.s- all I 24-4 <br />SA AQUIN Environmental Health Department <br />COUNTY-- <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />rpF0 Business Name: Owner Name: 1 0 i, i 1 k DatT.1 1 <br />Oweci-s! Doaci k Aillstvvi.tev-v , iv 1 clipit, obt_c_ils 72 2/2A <br />, CFO Physical Address: k''' CFO City: , CFO Zip: <br />1 GI SiT 1\)p4, I hi..( .F'ori aci . q 5 3 te Lo <br />Website (If applicable): Telephone: <br />ozo q #1/ <br />Categories: <br />0 "Class A" (Direct Sales Only) $186 EA "Class B" (Direct & Indirect Sales) 43-11 <br />Prohibited Items: Initial if you agree to abide by the following: <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 />51-10t1+ 'Ere. Food List: <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 />D City Water '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.sjgov.org/EHD