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Environmental Health Department Date: □“Class B” (Direct & Indirect Sales) $486 2. Prohibited Items: 3. Products: Food List: t 4. Product Labeling: 5. Water Source: *lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) 6. Food Processor Course: 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com isaiKa Attach two labels to this form for two of your CFO products (only one label is required if only one product is made). Attach food handler certification for owner and each individual that were not submitted with initial application (including family members and/or employees). COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING RENEWAL FORM Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness. Please check what type of water source is being used at the CFO: □ City Water Private Well* CFO Physical Address: LL Website (If applicable): CFO Zip: ^2-4-454^ 1. Categories: JX! “Class A” (Direct Sales Only) $186 or PcnvcfS, Covered u onagri Provide a list of all products you are preparing. If preparing jams, jellies, or fruit butters include a list of ingredients (attach separate page if needed). j □rjunsJTelU-eS , Mlar&hmalloiAJs , ChoccAaA-fol SANJOAQUIN ------COUNTY------- Greatness grows here. CFO Business Name: Owner Name: CFO Physical Address: CFO City: 2.4400 M • Tack TTne M Telephone: