Laserfiche WebLink
CFO <br />Date: <br />“Class B" (Direct & Indirect Sales) S486 <br />Ila ft <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />^Irxy vCpciorTCt <br />CFO Zip <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />EcTCity Water Private Well* <br />CFO Physical Address: <br />XST", <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 Avedue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <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: Al I J_ | <br /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />RtGISTRATION/PERMITTING RENEWAL FORM <br />J <br />pL&cIc, <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 />Justness Nanie <br />JOAQUIN <br />County - <br />1 • Categories: <br />ETx^lass A’ (Direct Sales Only) $186 <br />Environmental Health Department <br />(If applicable); <br />.|pT7X2</n__cyna n c? InCt/o J gcf' <br />, { ____i -LkzggfJ (OU1 £)' n / 7tz(<> j <br />(_.JLLPf \X42tilr' J q ,su>. <br />Prohibited Items: Initial if you agree to abide by the following: <br />Foods contaming cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />oo s that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />ese 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 />. Owner Name <br />.____ <br />CFO City <br />— <br />Telephone.