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Environmental Health Department <br />Owner Name: <br />Prohibited Items:2.lack <br />Products:3. <br />4.Product Labeling: <br />Water Source:5. <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />Food Processor Course:6. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />■ Incl and dessica McWhirter <br />CFO City: <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 />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 />Initial if you agree to abide by the following: <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-borne illness. <br />Provide a list of all products you are preparing. If preparing jams, jellies, or <br />ingredients (attach separate page if needed). <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />Taste of Grace______ <br />CFO Physical Address: <br />Please check what type of water source is being used at the CFO: <br />R} City Water Private Well* <br />Date: <br />4/24/2026 <br />CFO Zip: <br />SAN JOAQUIN <br />-COUNTY— <br />Greotness grows here. <br />1. Categories: <br />EJ “Class A” (Direct Sales Only) $186 <br />949 Zumstein Drive <br />Website (If applicable): <br />Ripon CA 95366 <br />Telephone: <br />(805)722-5272 <br />"Class B” (Direct & Indirect Sales) $486 <br />Food List:Sourdough baked goods.