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", t SANAOA0UIN p <br /> Environmental Health Department <br /> �\ z' COUNTY— <br /> SA <br /> ;FoaaP Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CFO Business Name: Owner Na e: Date: <br /> od <br /> The woeyl Sown P-a" 6odS N-C-N Vain (a'. od R6 1 ? 1 <br /> CFO Physical Address: CFO City:. CFO Zip: <br /> Z4 S 00umk L6141 fin o61,1 Rb3G G <br /> Website(If applicable): Telep one: . <br /> ?Oq �g23—�5RR <br /> 1. Categories: <br /> "Class A" (Direct-Sales Only) $155 ❑ "Class-13" (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: Quick 1/7reg.IXa PLL4* P<&Y .es, Cakes W i4i ` Koti-,�deinfiodiy <br /> �w zardaws "�i'f i ! i G'exs al- (0016 e,S COOlik'X& C c ,6C whes <br /> V 6t Vrt'51eit rats fUls ow <br /> s e <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). ()-IA lea& <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 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 />