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SAN JOAQUIN <br />r <br />Class A' (Direct Sales Only) SI86 Class B (Direct & Indirect Sales) S486 <br />3. Products: <br />MU '< <br />* v <br />5. Water Source: <br />*lf a private well attach all updated water sample results (including quarterly bacteria and Nitrate results <br />6. Food Processor Course: <br />1868 E Hazelton Avenue | Stockton California 95205 | T 209 468 3420, F 209 464-0138 | www S|cehd com <br />5 <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 />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 •'T~:. w ' <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Please check what type of water source is being used at the CFO <br /> City Water Private Wei’’ <br />Environmental Health Department <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 />CFO Zip <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 />•'oods 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 Name Owner Name <br />4t7 ~ Cuter _____L-op>m <br />CFO Physical Address CFO City <br />LiA4 G/LlCf^-fX p J ;,-jY I 1 i J O 'J S <br />Website (If applicable) Telephone <br />AC^u'i ' C-fctWX <br />1. Categories: