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* <br />Environmental Health Department <br /> "Class B' (Direct & Indirect Sales) $486“Class A' (Direct Sales Only) $186 <br />Food List: <br />'4- CtV-tached hs4-^~ <br />5. Water Source: <br />6. Food Processor Course: <br />1868 E. Hazelton Avenue | Stockton. CaWomia 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Created with Scanner Pro <br />P(2. 2500 <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 />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Please check what type of water source is being used at the CFO: <br />t^City Water Private Weir <br />If a private weH, attach aW updated water sampte results (including quarterly bacteria and Nitrate results.) <br />SANJOAQUIN <br />-----COUNTY----- <br />GrcatncJ? groi’S ^C'e. <br />Date: <br />CFO Zp: <br />^37^- <br />1. Categories: <br />¥ <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 />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 />2. Prohibited Items: Initial if you agree to abide by the followinq^-^L1^ <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-bome illness. <br />CFO Business Name: Owner Name <br />TVrxAS Vears_____rDX______________ <br />CFO Physical Address CFO City: <br />ivxIovine e Ln ._______u <br />Website Of applicable). Telephone <br />1510