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I u A U U Environmental Health Department <br />Date: <br />"Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />3. Products: <br />Food List: <br />Sprinkle il <br />j <br />Iftitkit cake <br />Sugar cookie <br />4. Product Labeling <br />iroduct is <br />5. Water Source: <br />6. Food Processor Course: <br />1868 E Hazelton Avenue St<ton California 95205 | T 209 468-3420 , F 209 46 vyww sjcehd.ccnn <br />03532. <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 />Attach two labels to th <br />made). <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 />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Permit# PP2400J72 <br />issued in Son <br />Joaquin County <br />Lodi.CA 952S2 <br />INGREDIENTS: All-pin pose <br />llour.sugar, butter, eggs, butter, <br />baking socio, soil, meringue <br />powder, vanilla, food coloring <br />rink It il <br />CFO Zip: <br />0\^2~ <br />INGREDIENTS ZVI purpose Bcul <br />buuw.sug.M.tWS. <br />spf.nUes.vnnoa. lK*ri>t) sucto uw <br />or wta'.bibno pewitlei. salt, looO <br />colomg <br />In Son <br />joaiui" County >401 WT ZOSOZtZMifli <br />. c.nto.ns wncot.soy eggs <br />odiry rwis <br />Made in Home Kitchen <br />Net WT lose oz(30g) <br />Contains Egg. wneat.soy <br />Mode in Home Kitchen <br />* <br />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 />Owner Name: <br />CFO City: <br />CFO Business Name: owlici ikame. ~ <br />CFO Physical Address: CFO City: <br />-KT^ CWin V /t/K , efi______1 <br />Website (If applicable): Te ephone: x . <br />Please check what type of water source is being used at the CFO: <br />KLCity Water Private Well* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />1. Categories: <br />“Class A” (Direct Sales Only) $186