Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> bye• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sicehd.com <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> �( CFO Business Name: Owner Name: Date: <br /> �n'rS Z_V _ is_442G - Am,: 6U,Qv0ee- - — 11 1�Ff/17 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 11947 w- VA.1a2a P8 " ruw Ccs 4 ,�-3 <br /> Website(If applicable): Telephone: <br /> �4^ 83�-=tgD6 <br /> 1. Categories: <br /> ❑ "Class X (Direct Sales Only) $133 "Class B" (Direct& Indirect Sales)$265 )� <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: Awa\,5 <br /> �nra s op�a�1 <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 <br /> product is made). <br /> 5. Water Source: <br /> Please check what type of water source is being used at the CFO: <br /> ❑ City Water Cyprivate Well* <br /> *If a private well, attach all updated water sample results(including quarterly bacteria and Nitrate results.) <br /> EHD 16-29 8/12/2016 1 CFO REG/PERMITTING RENEWAL FORM <br />