Laserfiche WebLink
pp YIN <br /> c° S A N,A��AQ N Environmental Health Department <br /> COUNTY <br /> \q/1 P� Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business NgXe: Owner Name Dater <br /> /,31,01 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> q est,. �•o cl g 5� <br /> Website(if applicable): Telephone: <br /> A VJf Ple S. C Drn a09- 0?- VA o <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155 "Class B" (Direct & Indirect Sales) $310 <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 /> 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 /> n A�►SIr1 lT; dee. <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). MADE IN A HOME KITCHEN <br /> PermitID# PT0024031 <br /> 5. Water Source: BAM Treats Mix 4oz <br /> Please check what type of water source is being used at the CFO: Lodi, CA 95240 <br /> City Water ❑ Private Well* 209-482-7846 cyndi@bamtreats.com <br /> *If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />