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,CFO Business Name: . Owner Name: <br />'KU lc) Rc <br />CFO Physical Address: <br />\Li <br />Website (If applicable): <br />ciAr)al e lrnC-V--‘1 re)r< CA • <br />Date: cd:2,z) 3 <br />CFO City: CFO Zip: <br />e C Ct 2.4) <br />Telephone: <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />--COUNTY - <br />Greatness grows <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Categories: <br />a "Class A" (Direct Sales Only) $155 El "Class B" (Direct & Indirect Sales) S310 <br />2. Prohibited Items: Initial if you agree to abide by the following: R. <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 />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 />cenc4 (o <br />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 />Water Source: <br />Please check what type of water source is being used at the CFO: <br />ID City Water rivate Well* <br />if a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />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 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com