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Date: <br /> "Class B" (Direct & Indirect Sales) $486 <br /> <br /> <br />label is required if only one product is <br />not submitted with initial application <br />CFO Zip <br />SAN JOAQUIN <br />------COUNTY----- <br />Greatness grows here. <br />1- Categories: <br />GJ) “Class A" (Direct Sales Only) $186 <br />vironmental Health Department <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 />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 />IcvMfeS - Pretzels - fFyKieS - Btygn <br /> <br />REGISTRATION/PERMnT’fNG <br />CFO Business Name: -JOwner Name | <br /> --------------------------logins CFO Physical Address:------------------------------------CFO City: ~~~ —————— <br />E OgJ(\ ST V-od-c <br />Website (If applicable): Telephone r- . „ <br />-------------------------------------5lQ_qiO BMia <br />5 Water Source: <br />' Please check what type of water source is being used at the CFO: <br />Pleasecr^ Private Well* <br />^ity Water <br />•If private well attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />C Food Processor-Course: <br />,or owner an?each individual ,hal were <br />0ncWn9'^membereanU’ <br />1868 E.HazeLon Avenue!». <br />id/or employees). <br />California 95205 | T 209 468-3420 | F 209 464-0138 I www.sicehd.com <br />4 product Labeling: <br />Attach two labels to this form for two of your CFO products (only one <br />made).