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CFO City: <br />\V1(2. E • Froga St. I-1 Alf\ <br />CFO Physical Address: <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />s it i=osz7.1.‘' <br /> Greatness grows h--- <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />Date 540 <br />CEO Zip: <br />Website (If applicable): <br />TetaC94 Irr Li 21 <br /> <br />Categories: <br />Vt. "Class A" (Direct Sales Only) $186 111 "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: xin <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 />SUl\„A r, <br />Food List: C., ciKe.,5 ‘,.1/ LA.A.t.,-(c „\ I Is; rw\ it, 1 C ook't5 <br />Product Labeling: <br />Attach one label to this form for one 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 />7r-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 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />1)09,0Aisio <br />CFO Business Name: <br />Nviic.lco, (ACV- CAkkt5 <br /> <br />Owner Name: <br />Xlit ‘e,PA 01/4 illkr <br /> <br />ingredients (attach separate page if needed). <br />KovykI Icrk)) nekcaronc, ‘,./tortietce in, <br />C,Apc_akeN ) 1,