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SAN JOAQUIN <br />_ u r <br />FRO941115 <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: Owner Name: Date: CFO Physical Address: CFO City: CFO Zip: <br />Perry's Food for the Soul: Stephanie Perry, March 6th, 2024 <br />Website (If applicable): Telephone: 925-435-9867 <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 <br />Prohibited Items: Initial if you agree to abide by the following: SP <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that <br />are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods <br />include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne <br />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 />Cakes, cookies, muffins, cupcakes <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 />City Water <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