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Food List: <br />S <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Namy--60 atO7r Name: <br />iCe (-Y1 ICEI ZOKan <br />Date: <br />5 /7 /,24 <br /> <br />CFO Physical Address: CFO City: <br />Aj, fluh n -7L <br />CFO Zip: <br />D . OP 1 95c2i)0 <br />Website (If applicable): Telephone: <br />CrTiTre a-,3 co rn a9/) 9- 4202_ 746 <br />Categories: <br />"Class A" (Direct Sales Only) $186 [i "Class B" (Direct & Indirect Sales) $486 <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 />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 />Made in a Home Kitchen <br />Issued by SJ County <br />Permit #PT0024031 <br />Lodi CA 95240 <br />,Ciourniel fiegildt Toffee <br />1/41b-11a4cr.7ilitkettorotate 3b/fee, <br />Contains: Almonds, Butter. Chocolate, Salt and Sugar <br />Made exclusively with Blue Diamond Almonds. <br />Gluten Free <br />d adt <7(a/whim, I 209.482.7846 <br />cyruclif@baintreato .com, I bamtreat4 .co m, <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 />4, City Water El Private 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 1 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />BAV <br />TATS