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—ui-- <br />4 <br />/ <br />CFO REG/PERMITTING RENEWAL FORM <br />1EHD 16-29 6/29/2015 <br />Date <br />slt^Uq <br />CFO Zip <br />Owner Narqe <br />:FO City <br />3. Products: <br />Provide a list of all products you are preparing If preparing jams, jellies, or fruit butters include a list <br />of ingredients (attach separate page if needed). <br />Food List: <br />5. Water Source: <br />Please check what type of water source is being used atthe CFO. <br />□ City Water Q Private Weir <br />•If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <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 <br />Only foods that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food <br />Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness. <br />4^ <br />"Class B" (Direct & Indirect Sales)^250 <br />pCFO Business Name <br />CFO Physical Address rPn fZ,-----~ <br />Website (if applicable) Telephone ,------------------- <br />------------------------—rdSM/ . <br />1- Categories: <br />□ "Class A" (Direct Sales Only) $125 <br />On 11 /VI monrj <br />Wey- C 2), f dIG <br />. C c gjn-c A mi 1 /G f COC.o_4pu^l4<-Ct CclO^G <br />b^aZ~i.S/ 1 <br />C_ \ l K, h<A3H5( ) <br />4. Product Labeling: <br />Attach two labels to this form for two of your CFO products (only one label is required if only one <br />product is made). <br />San Joaquin County <br />com