Laserfiche WebLink
s �Q SACC JOAQ IN COUNTY <br /> w <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 l=ast Hazelton Avenue, Stockton,ktan CA <br /> ,• � 95205-6232, <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s•cehd.com <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REG ISTRATIO N/P.E RNTTING RENEWAL FORM <br /> CFO siness am Owner N e: Rafe: <br /> CFO Physical Address: CFO City: CFO Zip:. <br /> N. <br /> VV,2bsite,Qf apciicabie�: <br /> 1. Categories: _---- <br /> ❑ "Class A" (Direct Sales Only) $125 N ;Class B" (Direct & indirect Sales) $250 <br /> I �- t .--- ---- - --, frsifia€ if you agree to abide by the following: <br /> Foods containing create, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br /> Only foods that are defined as "non-potentially hazardous" are approved for preparation by aCottage Food <br /> Qporation:=These foods include item_ s that.do not require refrigeration to keep them safe from bacterial <br /> .growth that coufd be-a 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 <br /> of ingredients (attach separate page if needed). <br /> Food List: <br /> C Cl- <br /> 4. Produdt Labeling: <br /> Attach two labels to this form for two of your CFO products (only one label is required if only one <br /> product is made). <br /> 5. Dater 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 /> EMD 16-29 6/29/2015 1 CFC REG/PERMITTING RENEWAL FORM <br /> . f <br />