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I <br />Environmental Health Department <br />0^ 5^8"-^ 3(^1 <br /> ■v <br />QA <br />V>rFc< A <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />SANJOAOUIN <br />-----COUNTY------ <br />Greotness grows here <br />1. Categories: <br />'gf “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 /> <br /> <br /> <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 />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 />CVxrrcW c gV\\ p C <Y2 <br />2. Prohibited Items: 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 />5. Water Source: <br />Please check what type of water source is being used at the CFO <br />[^Cily Water Private Well* <br />‘If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results ) <br />Date: . <br />CFO Zip <br />^20^ <br />CFO Business Name: Owner Name Cl <br />_C iasVoha _______ <br />CFO Physical Address CFO City <br />CrwKuA SV--------------- <br />Website (If applicable) Telephone <br /> "Class B" (Direct & Indirect Sales) $486