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Environmental Health Department <br />Date: <br />“Class B” (Direct & Indirect Sales) $486 <br />V) <br />SANJOAOUIN <br />-----COUNTY------ <br />Greotn>?js grows here <br />CFO Zip: <br />1. Categories^ <br />JTf^Class A" (Direct Sales Only) $186 <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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />'l^gity Water Private Well* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <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 />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 />_________£YYYAtJb>________ _________ ____________ _________________ __________ <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />2. Prohibited Items: Initial if you agree to abide by the following:^ — <br />Foods containing cream, custard, or meat fillings are potentially hazardou='^^XTFo^Oner^on7 <br />cause of food-bome illness. <br />OFOeua^N.^ Sbii^Name Qumi W <br />cfopk^s f <br />Webs«e (If applicable) Telephone: - (O V Z3'0