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uWl — <br />coo Keo , <br />\Aex\o\V\ f \ c\ <br />Environmental Health Department <br />1. Categories: <br />g4"Class A" (Direct Sales Only) $186 <br />CFO Business Name: <br />CFO Physical Address: <br />455 Fftlkrh&uM- <br />Website (It applicable): <br />3. Products: <br />Provide a list of all products you <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />pCity Water Private Well* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />are preparing. If preparing jams, jellies, or fruit butters include a list of <br />ingredients (attach separate page if needed). <br />Food List: { I'dCK&O-,—------- <br />Owner Nama . <br />(ri^__Hahib— <br />CFO City: <br />Telephone: <br />SANMOUIN <br />c uf -r - ------COUN I v------ <br />Grcotncss crows here <br />COTTAGE FOOD OPERATIONS (CF0) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Date: , <br />CFO Zip: <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 product is <br />made). <br /> "Class B” (Direct & Indirect Sales) $486 <br />... mc. Initial if you agree to abide by the following: <br />Foods containing cream, "US,art ^aZhlSVaXpS^^^^ <br />XV^od^—lems ZSo not re^uim refrigeration to keep them safe from bacteria, growth that <br />cause of food-borne illness.