Laserfiche WebLink
f� c SAN�►10AQUIN <br /> ° Environmental Health Department <br /> COUNTY o <br /> P ° <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) FEB 2 4 2020 <br /> REGISTRATION/PERMITTING RENEWAL FORWIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> CFO Business Name: Owner e: Date: <br /> sWed C"ahbnz Ab13 AIbolnlIC ►-QS-,),o <br /> CFO Physical Address: CFO City: CFO Zip: <br /> I1;644 waw t afi-)ruP ,CA �S33y <br /> Website(If applicable): T610S96-9m�phone:_ _ +9m <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155 V "Class B" (Direct& Indirect Sales) $310 <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: Su9Qr COQkaeS <br /> >,ary- gree MUM, <br /> cnocoQc�t e, b4ea ipre/tzeQ s <br /> orgy �i� �a�aft�1S <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 /> P'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 /> � � Su Z 59 3 <br />