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Owner Name.Date: <br />EHO 16-29 609/2015 <br />1 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br /><7/K ! <br />CFO Zip <br />75.57/ <br />1. Categories: <br />JZ “Class A" (Direct Sales Only) $125 <br /> <br /> <br />4- Product Labeling: <br />pXxt;s,o,his,ormfo^o°'y°- <br />CF0REG'PERM'niNG renewal form <br />5. Water Source: <br />/ Private Well* <br />V(2.0‘S'~\2.c,Mo <br />San Joaquin County FA oo 2 H iSS <br />Environmental Health Department <br />1868 East Hazelton Avenue. Stockton. CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sichd.com <br />CFO Business Name: <br />CFO Physical Address- ' <br />^5 E ftUrerh'ru^. p\(/€ <br />Website (II applicable): <br />2- Prohibited Items: |njtja| if you agree to abjde by the fo|lowjng: <br />O^?oodT?ha?aredef^Pri °r m6at fillin9s are Potentially hazardous and are NOT ALLOWED. <br />Operation. These foods include0^^’!^1^^3^05 are.approved for Preparation by a Cottage Food <br />growth that could be a cause of food-borne illness. Q refrigeration to keep them safe from bacterial <br />3. Products: <br />ol ingredients (attach separate page Sneededj.If prepann9 ’amS1 ie,lies' or fruit butters include a list <br />--------- <br /> <br /> <br /> <br />CFO products (only one label is required if only one <br />CFO City: <br />Telephone . <br /> “Class B" (Direct & Indirect Sales) $250