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Date: <br />1. Categories: <br />“Class B” (Direct & Indirect Sales) $250“Class A" (Direct Sales Only) $125 <br />Food List:L. i s-V fVtfr go V\ <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />1 CFO REG/PERMITTING RENEWAL FORMEHD 16-29 6/29/2015 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjcehd.com <br />CFO Zip: <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. <br />Only foods that are defined as “non-potentially hazardous” are approved for preparation by a Cottage Food <br />Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br />growth that could be a 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 <br />of 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 <br />product is made). <br />5. Water Source: <br />XP/ease check what type of water source is being used at the CFO: <br /> City Water Private Well* <br />Owner Name: r • x <br />N M I/Oi W <br />CFO Business Name: <br />CFO Physical Address: CFO City: <br />504 Motz-w rV (It ~7 ( <br />Website (If applicable): Telephone: