Laserfiche WebLink
Environmental Health Department <br />rioigj^r <br /> "Class B" (Direct & Indirect Sales) $486 <br />A^- <br />V <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: <br />A2 <br />CFO Physical Address <br />4A, GAtr 6A7ALP I Avr <br />Website (If applicable): <br />SAN JOAQUIN <br />C OIJ N T Y <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 <br />All 'puvpujf <br />bL r-j ^GtC <br />f-X <br />Owner Name: <br />A i£ A Ml <br />CFO City: <br />KlDVN PA t N HoOIB <br />Telephone: <br />r ^1 , <br />( C I^OCD <br />( C? I <br />I < <br />t"’de r f <br />A, / <br />4. Product Labeling: <br />Attach two labels to this form for two of your CFO products (only one label is required if only one product is <br />made). <br />3. Products: <br />Provide a list of all products you are preparing. If preparing jams, jellies, or fruit butters include a list of <br />ingredients (attach separate page if needed). <br />Food List: <br />6. Food Processor Course: <br />Attach food handler certification for owner and each individual that were not submitted with initial application <br />(including family members and/or employees). <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />2. Prohibited Items: Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-borne illness. <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water Private Well* <br />‘If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />Date: . <br />02 pS 2^0 2.- 6 <br />CFO Zip: I <br />, C c Q f CU tl g Y <br />VrfT./xxi <? | , ‘ <br />S0t L-? /.-$ IY7______________________C .