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Environmental Health Department <br />Hate <br />Telephone: <br />• < "Classy-(Direct & Indirect Sales) $486 <br /> <br />’coold-es <br /> <br />• > < <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Owner Name: <br />CFO City: <br />VgtfhfDp______. <br /> qzs- <br />1. Categories: <br />“Class A” (Direct Sales Only) $186 <br />2. 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 />Date: <br />CFO Zip: <br />8 5330 <br />ro^'a.l fciiAij. _F.uoj'ar <br />3. 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)>- - > (.•', * i <br />Food List: <br />Greatness grows here. <br />6. 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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />^.City Water □. Private Well* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />4. Product Labeling: - <br />- y.' <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). • , , ■ z <br />CFO Business Name: <br />10eg Gf/al nTce <br />CFO Physical'Address: <br />Website (If applicable):