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PR. 2SQG55S <br /> zx^y <br /> ’Class B’ (Direct & Indirect Sales) $486 <br />Ple< <br />*lf a private well, attach all updated water sample results (including quarteriy bacteria and Nitrate results.) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />6 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Environmental Health DepartmentSAN JOAQUIN <br />c oiiNi v <br />5. Water Source: <br />3>e check what type of water source is being used at the CFO: <br />City Water Q Private Well* <br />1. Categories; <br />fl 'Class A" (Direct Sales Only) $186 <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 />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 />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 <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 />CFO Butlnrsi Nnmo <br />CFO PhywIwH Addrvsn <br />WrHIte (II nppl'cnbk*) <br />MMH fif.UNKlfl C- WUH <br />CFO City t CFO 7t^ <br />SJL_______TMV/____________ <br />Tntephons <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 , F/FMPHftlz. <br />UKPrto TiL-lfthJO COOKIES>.fi9LVQgnAJ/ PEgAAf TP^-VSf______ <br />TU&oNrt Pf QW,____________________________ <br />rVeese ^o-e.