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Environmenial Health Department <br />vn\^es? V\<xV <br />*lf a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />1. Categories: <br />“Class A” (Direct Sales Only) $186 <br />CFO Business Name <br />CFO Physical Address <br />Website (If applicable) <br />kJ/A__________ <br />SANJOAOUIN <br />-----COUNTY----- <br />Grcotnca gfo»** here- <br />4. 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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />KI City Water Q Private Well* <br />6. 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 | Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />□ “Class B" (Direct & Indirect Sales) S486 <br />2 Prohibited Items: initial If you agree to abide by the following: <br />Poods conwnlng cream, custardI «; meal• f a Cottage Food Operation, <br />tokeep them sale from bacterial growth that could be a <br />cause of food-borne illness. <br />Owner Name: % <br />CFO City: <br />Xoj;________ <br />Telephone: <br />2oVz5I-??Z7- <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 />ingredients (attach separate page if needed). <br />Food List: Q <3oV-\e.9> z <br />. yjA\ QJrA 'SWa' sV\Ue.<- <br />COTTAGE FOOD OPERATIONS (CFO) <br />registration/rermitting renewal form <br />Date: . <br />CFO Zip: