Laserfiche WebLink
SANADAQUIN Environmental Health Department <br /> LA i!' ) —COUNTY— <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Ownerme: Date: <br /> �'l/ ) <br /> aop/f(/��rI1°P NINa ! Z l�(G �/P^ s 0/1g ��D�)O <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1 775 F6Cwi /0714,-� �� �'y33� <br /> Website Of applicable): Telephone: <br /> Slt� - 320 -- 22yZ, <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $155 ❑ "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: <br /> 4. P duct Labelin <br /> dach two labels to this form for two of your CFO products (only one label is required if only one product is <br /> mde). <br /> 5. Water Source: <br /> Please check what type of water source is being used at the CFO: <br /> City Water ❑ Private Well* <br /> *If a ' <br /> private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br /> at <br /> d ProcessorCourseh 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 />