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dP+4'yrH�� <br /> ` SAN JOAQUIN.COUNTY 111 <br /> f . ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-5232 <br /> {{Fd' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'cehd.com <br /> COTTAGE FOOD OPERATIONS (CFO).. <br /> REGISTRATION/PERMITTING RENEWAL FOR!",9I <br /> CFO Business fame: Owner dame: Date: <br /> rW 15 TEA eu po_A ke S n t 7 <br /> CFO Physical Address: CFO.City:. CFO Zip: <br /> _-3iog3 6&rden 6t S <br /> Website(If aoolicable): Telephone: <br /> 11L'�- - -m - <br /> 1. Categories: - - - -- - --- <br /> "Class A"(Direct Sales Only) $125 ❑ "Class B" (Direct &Indirect Sales) $250 <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. <br /> Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br /> Operation. These foods include items that do not require refrigeration to Keep them safe from bacterial <br /> growth that could 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 /> euioew,kes ekk_p-sl <br /> ,k <br /> 4. Product Labelin : <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. Water Source: <br /> Please check what type of water source is being used at the CFO.- <br /> EJ <br /> FO:❑ City Water Private Well* ` <br /> *If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br /> EHD 16-29 6/2912015 1 CFO REG/PERMITTING RENEWAL FORK! <br /> . 5 <br />