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‘Class B' (Direct & Indirect Sales) $486 <br />T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />SAN JOAQUIN <br />COUNTY <br />Telepho/e- <br />CFO Physical Address: CFO City. <br />q/o C;x. ~T <br />Websrte (If applicable)- <br />rP' co2~i \ <br />Environmental Health Department <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />City Water Private Well* <br />*lf a private well, attach ail updated water sample results (including quarterly bacteria and Nitrate results.) <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 />3. Products: <br />Provide a Fist 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 />j2 c -c.___________________________ <br />1. Categories: <br /> ‘Class A" (Direct Sales Only) $186 <br />2. 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-bome illness. <br />6. Food Processor Course: <br />Attach food handler certification for ov/ner and each individual that were not submitted with initial application <br />(including family members and/or employees), j/' <br />1868 E Hazelton Avenue | Stockton, California 95205 <br />CFO Zip: <br />_____