Laserfiche WebLink
SANA0AQUIN <br />Iia r <br />Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM AF <br />R73 2021 <br />CFO <br />Siness Name: Owner Name: MF�RvlCEgQD000Ga E+T0NS <br />CFO Physical Address: CFO City:, CFO Zip: <br />564 Ai ea:riArbkty _ CoIAfL� A pj– —1i `Srrbalexon! G4 Ci51D5 <br />Website (If applicable): Telephone: <br />hTiceJc,reA-4�D✓i5 Z_D P_ <br />1. Categories: 5rvo_�I �m <br />K "Class K (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 <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 AL OWED. 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 -borne illness. <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: <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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water <br />❑ Private Well* <br />*If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <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 I Stockton, California 96205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />