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Environmental Health Department <br />^5 <br />Date: <br />“Class B” (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />3. Products: <br />Food List: <br />rOtxrArons, mm, eo<w <br />Sagar cookie <br />4. Product Labeling <br />iroduct is <br />5. Water Source: <br />6. Food Processor Course: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.cc"n <br />p^oori'2. <br />Attach two labels to th <br />made). <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 />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 />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Permit* PR2aOO372 <br />issued in San <br />Joaquin County <br />Lodi CA 952fl2 <br />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 />Pcntiit* PP2A00.VJ <br />ibsuaa m San <br />Joaquin county <br />LoOiCA <br />INGREDIENTS All purpono <br />Hour,sugar, bultor. eggs butter, <br />baking soda. salt, meringue <br />powdoi. vanilla, toad coloring <br />rinL11 il <br />CFO Zip: <br />“Class A” (Direct Sales Only) $186 <br />rinklc il <br />Net WT 1058ozt30g) <br />Contains Egg wheatsoy <br />Made in Home Kitchen <br />1. Categories: <br />Sgnnlle Cats <br />INGPtMENTS AS twrw <br />tunri ns)' m* vroeut*- « <br />K-mklesvanUU !>.*.■Ml ■.«>-> ' <br />or tarw bASMM) (■w*' ,ood <br />colonrM) <br />^CV-^WOAOUIN <br />sff Bosh'S1 <br />CFO Business Name: . Owner Name: A <br />CFO Physical Address: CFO City: J <br />-vffi TobM cwn . cfi <br />sr <br />moi w’ 1 'jioztjmgi <br />contains wnoot.sov oggs <br />dairy nuts <br />Made m Home Kitchen <br />Please check what type of water source is being used at the CFO: <br />FZLCity Water Private Well* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.)