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Environmental Health Department <br />Date <br /> "Class B (Direct & Indirect Sales) S486Class A’ (Direct Sales Only) SI86 <br />3. Products: <br />Food List. <br />i- <br />t <br />•If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results ) <br />1868 E Ha/elton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464 0138 | www sjcehd com <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />SAN JOAQUIN <br />COLI N T Y <br />2. Prohibited Items: Initial if you agree to abide by the following: I ' <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 />1^41 w <br />CFO Zip <br />6. Food Processor Course: <br />/-.ttach food handler certification for owner and each individual that were not submitted with initial application <br />(including family members and/or employees) <br />5. Water Source: <br />Please check what type of water source is being used at the CFO <br />(Efcity Water Private Well* <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 />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 />Coo^i^,, (rnSfws/ <br />Mrmmc’Yi rolls j mix , cooFig mix Cdm <br />CFO Business Name . Owner NameiWeer WvHft \ ij n jcVu;Io p nw <br />CFO Physical Address CFO City. <br />ZH' (.udid Ayr- SWW <br />Website (If applicable) Telephone <br />WWW - _____‘W\ <br />S W cf I c\ (Vd |&K/Yt'1 / <br />1. Categories: <br />0