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SAN JOAQUIN Environmental Health Department <br /> 'Class B' (Direct & Indirect Sales) $486 <br />Knifes <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />VYUA VXKA <br />SC CTY-x£<o <br />5cxuz£w^kJ Vnc Cetecs <br />Dale: < <br />3JJZ125. <br />CFO Zip. <br />1. Categories: <br />^3 -Class A' (Direct Sales Only) $186 <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). <br />Food List: <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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />-p^City Water Private Well* <br />*|f a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />2. Prohibited rierns: iniiiai if you agree io 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-potenbally 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 />A, <br />450lCr<?to <br />SOucrdo <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 209 468-34201 F 209 464-0138 | www sjcehd com <br />CFO tone O^ner tome: . x <br />rV Vi a MuAfoi/O <br />CFO Ptiywcal AddreXA V. <f\CFO <br />Website (if appiicaWe): Telephone-