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nt <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />SAN JOAQUIN <br />-COUNTY- <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 />maoe <br />1. Categories; <br />“Class A" (Direct Sales Only) $186 <br />5. Water Source: <br />Please check what tvpe of water source is being used at the CFO: <br />^City Water Private Well* <br />•If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results ) <br />cxin <br />6. Food Processor Course: <br />attach food handler certification for owner and each individual that were not submitted with initial aoplicaton <br />(including family members and/or employees). <br />1868 E Hazelton Avenue | Stockton Calrfornia 95205 | T 209 468-3420 | F 209 464-0138 I www sjcehd com <br />CFO Business Name <br />Q e Cttj’or) s n b fOnon <br />CFO Physical Address <br />2i|o yV <br />Website (If applicable). <br />9 (2.'2400 3'14 <br />Environmental Health Deparfmd <br /> “Class B" (Direct & Indirect Sales) $486 <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 ? <br />cause of food-borne illness <br />““ ^^5/2.5 <br />CFO Zip <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 neeoec, <br />Food List (jopcls <br />CAt-'d d'JJ__________ <br />Degcriphcon • m.lce.5 uxhb 0>ur (-Q4C <br />(ouer . lej/- <br />vwnei Kdlire. <br />Ewhikci <br />CFO City <br />I^IouhVc <br />Telephone <br />Q 25-62g ~3 9 <br />o/z co Sect <br />CX^A, vaJ ““