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AUG 0 1 2025 <br />Owner Name:Date: <br />"Class B” (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />3. Products: <br />5. Water Source: <br />COTTAGE FOOD OPERATIONS (CFQ)nvironmental health <br />REGISTRATION/PERMITTING RENEWAL FORWIMit/services <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />SAN JOAQUIN <br />------COUNTY------ <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 />Pieape check what type of water source is being used at the CFO: <br />Wfcity Water □ Private Well* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />Environmentalp^Q^j^^^ent <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 <br />4. Product Labeling: <br />Attach two labels to this form for two of your CFO products (only one label is required if only one product is <br />made). <br />Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-borne illness. <br />CFO BusinessJMame: . \ . ■. \ ,$ wk WhAX Tq V <br />CFO Physical Address: \ <br />in . <br />Website (If applicable): <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).