Laserfiche WebLink
SAN IJOAQUIN <br />1P¼ OO2t <br />Environmental Health Department <br />COUNTY <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL F RM <br />44 rEiCATAI-D) Av&Tr DE <br />f•••••• <br />Owner Name: Date: <br />ASH 112 A tn 12AvictiA..lbtobA )212 diozit <br />CFO City: CFO Zip: <br />MO UNITAllsk 14004E- <br />s1 23 733S-1 <br />CFO Business Name: <br />A2- BAkESHoilE <br />CFO Physical Address: <br />131 I <br />Wei:mite (If applicable): Telephone <br />Categories: <br />/RI "Class A" (Direct Sales Only) $186 In "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: A <br />Foods containing cream, custard, or meat f Dings 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: y ir c5itAik Fel ubettY u_tr;A <br />BCtie aej DIAS ISta-1-1 M'tI Lie CotLe-lf , forJa.AL Salt- <br />k c_11.11 &LA 6 bate r t cLiU CavrAel <br />t&-A ;&ctt LD L01*-1-t C.oveie ptL.JIe looct , <br />AtIAAA.4,0124%ti, tear 2, Cu re-Aite_i ,e_04.) ?ors . <br />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 />Water Source: <br />Please check what type of water source is beihg used at the CFO: <br />92 City Water DI Private Well <br />"If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />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 1 T 209 468-3420 I F 209 464-0138 1 www.sjcend.com