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P/? OSTy <br />Environmental Health Department <br />rClass B” (Direct & Indirect Sales) S486 <br />preparing. If preparing jams, jellies, or fruit butters include a list of <br />F 209 464-0138 | www.sjcehd.com <br />SAN JOAQUIN <br />COUNTY----- <br />"Ku/lZuX®! SY) <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 />I I I uLiC, J. <br />3. Products: <br />^HrAdilntc5/ ah productts you ar® Prepping. If preparing jams, jellies, or fruit butters include a list of <br />ingredients (attach separate page if needed). <br />Food List: <br />jye.e-ie ieA Axj SxacVa c\s SVMcS , c\\<Vtf <br />1. Categories: <br /> "Class A" (Direct Sales Only) $186 <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />Clty Water Private Well* <br />'If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />6. Food Processor Course: <br />each indlvidual tha‘were not sub™lted with initial <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />2. Prohibited Items: Initial if you agree to abide by the following: Q <br />fFZoS(“.n!a'nT(Cream' .CUStard’ °r meat ,illln9s are Potentially hazardous and are NOT ALLOWED Only <br />(h d ,h are TT5? aS non’P°tentlal|y hazardous" are approved for preparation by a Cottage Food Operation* <br />cause of food-born: illX ' t0 Safe fr°m baCterial 9rowth that could be a <br />CFO Business Name: Owner Name: <br />CFO Physical Address. 1 CFO City: <br />-I3>(o) Peffce.ya CAr <br />Website (If applicable): Telephone: <br />------------------- ---------o2>%n <br />Date: <br />CFO Zip: <br />OA53?>~)