Laserfiche WebLink
G <br />-7^ <br />“Class B" (Direct & Indirect Sales) $486 <br />RECEIVED <br />SEP 04 2025 <br /> ENV IRONMEMAL HEALTlf <br />DEPARTMENT <br />1. Categories: <br />'^^“Class A" (Direct Sales Only) $186 <br />one label is required if only one product is <br />SAN JOAQUIN <br />COUNTY------ <br />Owner Name: . <br />g€ Iur<47;_ C1^ <br />CFOCity: CFolT^' <br />d^La^-h-e.?.____________ <br />Telephone: <br />e/\S t c, C >n^ <br />V <br /> <br />CFO Business Name. <br />u, f cVi C c> -c/’s <br />CFO Physical Address <br />^7,3 I . /A | m q <br />Website (If applicable): <br />Ly> CO vQ 4 co bio I <br />Accou.n4>na <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />4. Product Labeling: <br />mad^) tW° labelS t0 th'S f°rm f°r tW° °f y0Ur CF° products (on|y <br />preparing. If preparing jams, jellies, or fruit butters include a list of <br />Pg o*? 14 <br />Environmental Health Department^ <br />2. Prohibited Items: |nitia| if yOu agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWFD rrniv <br />3. Products: <br />Provide a list of all products you are p “ <br />ingredients (attach separate page if needed).' <br />Food List: <br />V"~Io I -e c S____ <br />C<;o )o’S <br />C <^1 c.V [n Cao ku .c \ <br />5. Water Source: <br />P/ease check whatty/fe of water source is being used at the CFO: <br />City Water / Private We||* <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />6. Food Processor Course: <br />XiXliXXSXSeach individual that were not “d with ini,ial applioatlon <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />haS 0r^\n«d2.