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“Class B" (Direct & Indirect Sales) $486 <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd com <br />r^054#rl3 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />4331 -v | <br />Environmental Health Department <br />1. Categories: <br />“Class A" (Direct Sales Only) $186 <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 />made) <br />5. Water Source: <br />Please check what type 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 />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 needed) <br />Foodust Sourdough Jsreac/s, Raffles boikec/gopc/^,___________ <br />marishnia.llo\A/s, drier/ Q-utfs ana ityetiipjes <br />6. Food Processor Course: <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 />SAN JOAQUIN <br />- COUNTY- <br />G' < uf/iess t/i Oivs iii’iC <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 a <br />cause of food-borne illness. <br />CFO Business Namq: Owner Narne:__^ <br />dcAj Rise_______•Myrul EhxS___ <br />CFO Physical Address: / CFO City: <br />724 Vwi Wmi Ripon_____ <br />Website (If applicable)*J T^phoge <br />Dale 2/Z7M <br />CFO Zip-