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OP(1UIty <br /> N' 'cr, SAKdOAQUIN Environmental Health Department <br /> .� COUNTY R2Czym:`gc =oc+"'`P Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) APR 20 2020 <br /> REGISTRATION/PERMITTING RENEWAL sRvicEsLrH <br /> /WITECF Business , me: Ow er Name: Date: <br /> 6 SCo 12Z2h <br /> CFO Physical Address: CFO City: CFO Zip: <br /> CW i 9°I U0 ��Lg CCk- !RS?q l <br /> IL <br /> Website(If applicable): 2 Telephone: 9 <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales) $310 <br /> (' ey__ W0.S mall,01 Ccksnecl <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOTFLOWED. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of food-borne illness. <br /> 3. Products: <br /> Provide a list of all products you are preparing. If preparing jams,jellies, or fruit butters include a list of <br /> ingredients (attach separate page if needed). _ `lc,� -i <br /> Food List: p O�YAA C ,5-c „ ona b`(p (Y 0-&_zcb <br /> M 01-5i$fl MC.IMCJvt) <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 />