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"Class B" (Direct & Indirect Sales) S486 <br />HD <br />3. Products: <br />Food List: <br />scones, sourdough bread <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <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 />Website (If applicable): <br />www.rollinsconez.com <br />?\2. <br />Environmental Health Department <br />CFOZip: <br />95376 <br />Date: <br />6/30/25 <br />SAN JOAQUIN <br />----COUNTY - <br />Greatness qrows here. <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 />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 />Owner Name: <br />Heather Drumgoole <br />CFOCity: <br />CFOBusiness Name: <br />Rollin Sconez <br />CFOPhysical Address: <br />293 W 22nd St Tracy <br />Telephone: <br />(209) 650-9644 <br />5. Water Source: <br />Pleasecheckwhattype of water source is being used at the CFO: <br />Sf City Water Private Well* <br />itegories: <br />lass A" (Direct Sales Only) $186 <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. Only foods <br />that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food-borne illness.