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(V OSM3^3>| <br />Environmental Health Department <br />4 so --7^6-72,?^ <br />“Class B’ (Direct & Indirect Sales) $486 <br />Food List <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Tetephdbe: <br />vK . Co *vx <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING RENEWAL FORM <br />CFO Business Name Owner Name: . / <br />CFO Physjcai Address CFO City. <br />SIO <br />Website (If appScaWe): <br />to <br />SAN JOAOUIN <br />-------COUN“Y------- <br />G-tfCtnc5$ crops r.j-. <br />1. Categories: <br /> ‘Class A’ (Direct Sales Only) S186 <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 />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 />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />^'City Water Private Well* <br />•If a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <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 />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), y <br />CFO Zip