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PK 65-y <br /> S A N I O A Q U I N Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name Owner Nmmn: L7oW <br /> Briltney Menrlin 01007=26 <br /> GFO Pfi"k P Address CFO City: CFO Z,p� <br /> 7tfii37"rirle Rd Escalon 96320 <br /> Website(If aaptcaNe)' Telephone: <br /> Rry Al *i h�$cx3.n 209CAI.7611 <br /> 1. Categories: <br /> YJ "Class A"(Direct Sales Only)$186 ❑ "Class B"(Direct&Indirect Sales)$486 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: _BM <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 Cparation. <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 ingredients <br /> (attach separate page if needed). <br /> Food List: Sugar Cookies;Powdered Sugar, Unsalted butter,Vanilla, Eggs,Flour,Salt. Baking Powder <br /> 4. Product Labeling: <br /> Attach two labels to trod;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 helrlg used at the CFO: <br /> 1-1 City Water LI Private Well- <br /> 'It a private well,attach all updated water sample results(including quarterly bacteria and Nitrate results.) <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 andlnr ernployees). <br /> 1868 E. Hazelton Avenue i Stockton.California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.Qom <br />