Laserfiche WebLink
-M SAN.DJ QAQ U I N Environmental Health Department <br /> � COUNTY <br /> `..C' I Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Own r Name: Date: <br /> �zrno4 len Soy4►piJ ,�r�rra i ne i Y_L- -)5 JU <br /> CFO Physical Address: CFO City: CFO Zip: <br /> D c+ lto yada <br /> Website(If applicabl Telephone: <br /> 12 0 qAa�-�i <br /> 1. Categories: <br /> [Class A" (Direct Sales Only) $155 ❑ "Class E" (Direct & Indirect Sales) $31.0 <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 /> a , <br /> 7S <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-1CityWater El Private Well* �C�11' 01 Un 11 <br /> vV l <br /> Sa+� 0-,-0\ (.c-t4 t <br /> *If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) CiIvT;,-t <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 />