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Environmental Health Department <br />A <br /> “Class B” (Direct & Indirect Sales) $486 <br />UVlilwJ. <br />r i uuu^ta. <br />Food List: <br />4.Product Labeling: <br />5.Water Source: <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />6. <br />vUo^iv^-6 <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 />release cneCK wiidi type ui waitu source is ueniy useu hi ure ^ru. <br /> City Water Private Well* <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 />Miidvii i'uuu iiaiiuici ueilinuaiiuit iui mwviici diiu caui liKjiviuuoi uiai vvetc iiui ouMitiHieu vviiii iiiiuai appnuatiuii <br />(including family members and/or employees). <br />SAN JOAQUIN <br />COUNTY- <br />1. Categories: <br />“Class A” (Direct Sales Only) $186 <br />OO\ <br />Food Processor Course:1868 b. Hazsiton Avenue'] StWKtOn, Cantorma 9b205 | T 20V 468-3420 I F 2U9 464-0138 I www.sjcehd.com <br />Date: <br />CFO Zip: <br />_________9s j <br />CtW Pop, f t<A)(Ano OS lcooMt^> <br />~ AA 0 jo _____________ <br />CFO Business Name: Owner Name: <br />Rosi C-ON>FIC AkO to t <br />CFO Physical Address: CFO City: <br />Website (If applicable): Telephone: <br />• ?>? — a— . . jT- _ <br />>• JWM Mtp IGXJ KW OMIUG MJ kl IVIIVVVHiK|. <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 />CTfluir)