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Environmental Health Department - CO UM □“Class B" (Direct & Indirect Sales) $486 Food List: &■ r- *lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) f 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com o^ (only 6. Food Processor Course: Attach food handler certification for owner and each individual that were not submitted with initial application (including family members and/or employees). 2. Prohibited Items: Initial if you agree to abide by the following. 7^/^, Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as “non-potentially hazardous” are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness. 3. Products: Provide a list of all products you are preparing. If preparing jams, jellies, or fruit butters include a list of ingredients (attach separate page if needed). 4. Product Labeling: Attach two labels to this form for two of your CFO products (only one label is required if only one product is made). al r SANJOAQUIN Dignify Hy^ltK St/jos^pF'^ Medial-Centerrc- St. Joseph’s Medical Center 1 800 N. California St., Pavilion Stockton, Ca. 95204 COTTAGE FOOD OPERATIONS (CF^ REGISTRATION/PERMITTING RENEWAL FORM-g Date: CFO Zip: CFO Business Name: Owner Name: ________X //a n CFO Physical Address: CFO City: 5 +.0 C Website (If applicable): Telephone: 1. Categories: “Class A" (Direct Sales Only) $186 5. Water Source: Please check what type of water source is being used at the CFO: tfZ'City Water □Private Well* Cs^e.