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paurry Oo 2 <br /> _'o SAN4JOAQUIN Environmental Health Department <br /> \�',', � —COUNTY- <br /> 4,�ou P Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> CSF �BusIness.Name: Owner Name: Date: <br /> I YID P�GL�Y, bAVE C'Inr_� lenoitr LC[u)sn'1 3,36'2.02.1 <br /> CFO Physical Address: CFO City:. CFO Zip: <br /> aoi qq W i c>Llu,noll, ed -"acv Eac153q/ <br /> Website(if applicable): ephOne: 923 0-5-714 <br /> 1. Categories: <br /> A—"Class A" (Direct Sales Only) $165 ❑ "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 NOTED <br /> . Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottaperation. <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-bome 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: IF`V A <br /> C`),-.hinae cr.i r�r,r r i`eFUS . � rna i�rtct1ic�c)� <br /> cAin <br /> i <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►att the CFO: <br /> ❑ <br /> City Water �I 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 />