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fR 0 s S6 2.-0 <br />21 <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY — - <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: Date: <br />Saint Pete's Bakery David Rainwater 4/2/25 <br />CFO Physical Address: CFO City: CFO Zip: <br />1849 Orvis Dr. Stockton 95209 <br />Website (If applicable): Telephone: <br />209-639-5913 <br />1. Categories: <br />X "Class A" (Direct Sales Only) $186 E "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: <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: <br /> F0-c- 7\ c\ C2-0j-t-QcJi-e- 5 2-ki 210 <br />Bagels, bread, cookies, pancake mix f\A C;;\/ 'Q-C-..(\ vc,.J\-e- 3-26- Z 0 <br />\c\c12 ‘\--1 <br />c=vot 2c\ct 2.-19 (4 s) <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 />cg City Water fl 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 1 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />Initial if you agree to abide by the following: DR