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` .. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />crO "—rOaner Dyne Dare. 3 - l' 2' <br />911 {. I. Al � e��uj1 P11hlNl—PA1 r RU(Udd0 3 <br />CFOF`r._.:x 4^C•F�7 CFO :41V CF„ Zip <br />3..il�' "ti�i r\ L.iiL SNCF'1�'t �1SZO� <br />:•.eys'e , ax!M1&7et Tele;Yhorm. I, I �� tc19 n `- <br />1. Categories: r <br />5j 'Gass A- (Dred Sales Only) $186 ❑ 'Class t3" (Direct 8 Indirect Sales) $312 <br />[. 7rohibited I:ems: Initial if you agree to abide by the following: <br />F;u1_ antainmg cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />o -ds Mat are de:•ned as -non-.-otentially hazardo s' are apprcved for dre, araticn by a Cottage Fad Oaeratirn. <br />These foods indu!e items that do not require refrineralion to keep them safe from bacterial growth that could )e a <br />cause of food-.wme 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 />r,gred:ents iattach separate page if needed). <br />Foo,ZUSV uok-:•t, wrd, Qui-( i of 4,t fyw catim �nitmj lV)Mral,Mt <br />In, 40- <br />4. Product Labeling: <br />Ararh one label to this form for one of your CFO products (only one label Is required If only one product is <br />made) <br />5. Water Source: <br />P%ease check what type of wafer source is being used at the CFO, <br />City Water ❑ Private Well' <br />If a private we!', attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />6. Food Processor Course: <br />Attach food handier rAnificat on for ovmer and each individual that were not submitted with Initial application <br />(including family members andior employees) <br />1863 E Hazelton Avenue i Stock on Ca!dorn a V52051 ' 209 468.342J I F 209 404.0138 1 +ww s*gov org!LHD <br />i60'r <br />