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P <br />SANJOAQUIN <br />COUNT Y-- <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name: ,t 13, Owner Name. f e r a4ota__ <br />CFO Physical Address: CFO Ci_ty: <br />\ k.0550 1,0 • To (A. (-44‘.._ <--- . IV-.1 p CS'i\. <br />Wetite (If app JI.e(&le) Telephone: <br />(d` 00-11L-40 --(2 <br /> <br />Date: <br />19 - 4 <br />CFO Zip: <br />cA153 <br /> <br />Categories: <br />IS. 'Class A" (Direct Sales Only) $186 D "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: Or <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 />5k bc-eo <br />r-cfo IA MAL RI 6\ori \'\ "Za.r-ct o cc-) <br />ow-d DLX4h c <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 />City Water 1 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 www.sjgov.orgiEHD