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rx 2^3/3 <br />Environmental Health Department <br />O*nef Nnmr <br />® -Class B’ (Direct & Indirect Sales) $486 <br />3. Products: <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <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 />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />SANJOAQUIN <br />-----COUNTY— <br />Gfcflfnm hen <br />1. Categories: <br /> "Class A’(Direct Sales Only) $186 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Escaneado con CamScanner <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 following: 7VA <br />Foods containing cream, custard, or moat fillings are potentially hazardous and aro 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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water Private Well* <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 />L'-l <br />Food List <br />4K iter I ujklc (pfH- <br />iMo-tev <br />CFOZ^rCfO City; <br />Teteohone <br />CFO Business Namo_ > i f3 roof lit <br />CFO Phystefll Address <br />Website (If nnobcnNcl