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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />Greatness grows, here, <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name , Owner Name: Datg: / _ <br />L-0 (VIGO ()veil Ira (19 ix 3/07../zezi <br />CFO Physical Address • CF City: CFO Zip: <br />1-1397 aiWpaz gd <br />Website (If applicable): Telephone: <br />P-Oq W9-757, 7 <br />Categories: <br />"Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $312 <br />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-borne illness. <br />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 />91/6,1 Spices -r Teas' <br />woiott - <br />kftt <br />lrciulrrlix <br />- COoeiel i Mei <br />Product Labeling: <br />Attach one label to this form for one of your CFO products (only one label is required if only one product is <br />made). <br />dty cI <br />Please check what type of water source is being used at the CFO: <br />111 City Water )A Private Well* MI stnd ci waive <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 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />Water Source: