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n <br />i <br />■ <br />rMc - <br />T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />ICOTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Environmental Health Department <br />rf\ <br />1. Categories: <br />'Class A' (Direct Sales Only) $186 <br />CFO Business Name: <br />Bake It Up <br />CFO Physical Address: <br />2915 Coventry Drive <br />Website (if applicable): <br />Owner Name: <br />Ashley Fonttlla_______ <br />CFO City: <br />Tracy_____________ <br />Telephone: 510-709-8545 <br />Date: <br />06/30/2025 <br />CFO Zip: <br />95376 <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />E] City Water Private Well* <br />•If a private well, attach all updated water sample results (Including quarterly bacteria and Nitrate results.) <br /> "Class B'(Direct & Indirect Sales) $486 « <br />2. Prohibited Hems: Initial if you agree to abide by the following: <br />ssssssssssss <br />cause of food-home illness. <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | <br />3. Products: <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 />Food List & VARIETY OF MACARONS, CAKE POPS, SCONES, COOKIES, AND OTHER BAKED GOODS. <br /> SEE ATTACHED FORM. _________ _ <br /> <br /> <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 />4f^SAN>J0A0UIN <br />* ------COUNTY------- <br />Greatness grows here. <br />V“**------i