Laserfiche WebLink
Maui" SAN 0A0UIN a <br />� Environmental Health Department <br />—COUNTY <br />— <br />Greatness 9 <br />cP/ Gtness rows here. <br />'gClFOR,.. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: 84 rbGr� ��t Date: <br />N 1'c: Y, . 6c4r'bcr^ F4rrKS N.CIC kcl-fto -7/9/)9 <br />CFO Physical Address: CFO City: CFO Zip: <br />H350 S. Juct 'TE)nc 4d, kuni'ccc. 5 334 <br />Website (If applicable): Telephone: <br />1. Categories: <br />❑ "Class A" (Direct Sales Only) $155 [X "Class B" (Direct & Indirect Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: /\J 4 P�1 <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: J U M — (n5 <br />reef len-f5 ._ S jCir ti'- JenN0� 'v�Ce <br />5 ,, � . l ,, mE c: ti,) . h , %-flie <br />()a}-mcaJ Acl isrn C Coo;eS. <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 />5. Water Source: <br />Please check what type of water source is being used at the CFO.- <br />F-1 <br />FO:❑ City Water ,Private Well* <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 />S <br />