Laserfiche WebLink
SAN JOAQUIN <br /> <br />Environmental Health Department <br />— - C Oil N T Y - — <br /> 1.t\.2S -\-Q <br />flk002kobq 8 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name <br />NzyS M1\G11(._ <br />CFO Physical Address: <br />1021 fYc <br />Website (If applicable) <br />Owner Name. Date. <br />IMCENR1<ql fiRvKvii..11 <br />CEO City: City: CFO Zip <br />TREACY <br />Telephone <br />cq 1c7' <br />z <br />-Class A- (Direct Sales Only) $186 "Class Ef (Direct & Indirect Sales) $486 <br />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 />Food List: Ail liachfA <br />y6s-S515- • <br />03(AD) <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 />0/City Water ID Private VVell* <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 <br />1. Categories: