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Environmental Health Department <br />i <br />Website (If applicable): <br />2. Prohibited Items: <br />If preparing jams, jellies, or fruit butters include a list of <br />* <br />-I <br />K- <br />Attach two <br />made). <br />CFO Business Name <br />'The ifos <br />CFO Physical Address CFO Z<p <br />1. Categories: <br />“Class A" (Direct Sales Only) $186 <br />Owner Name <br />•AlCxU ftetancodrT <br />CFO City: <br />Telephone: <br />' PkBcO^2;^ <br />one label is required if only one product is <br />4. Product Labeling: <br />labels to this form for two of your CFO products (only <br /> “Class B" (Direct & Indirect Sales) $486 <br />Initial if you agree to abide by the following: ------- <br />Foods containing cream, custard, or meat fillings are potentially hazardous and a^e □^Food'operation <br />s^i-sassssxiBs^^ »• <br />cause of food-borne illness. <br />SAN JOAQUIN <br />L’i ' COUNT Y <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />.X- ■ <br />3. Products: <br />Provide a list of all products you are preparing. <br />ingredients (attach separate page if needed). <br />Food List (,onchnls, ^rdouqh frTyqd.cVwtoWechip <br />rWocoUifc twerrd-nqrfO <br />nyptel, furxaVU , foanana &read, fotad , coH pops, <br />uyx » hdVffd - ------------------------— ■ <br />6' SSZSZ: for and each indMduai iha. net — iniiiai appiieaton <br />(including family members and/or employees). <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | WWW.Sjceh <br />* <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />$ City Water Private Weil- <br />•If a private well, attach all updated water sample results (including quarterly bacteria and N.trate results.)