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P2. 25.00 12^ <br />2. Prohibited Items: <br />209 468-3420 1 F 209 464-0138 | www.sjcehd.com <br />5 <br />CFO Zip: <br />ier and each individual that were not submitted with initial application <br />and/or employees). <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T <br />5. Water Source: <br />Please check what type of water source is being used at the CFO: <br />^City Water □ Private We.r <br />*7a private well, attach all updated water sample results (including quarterly bacteria and Nitrate results.) <br />6, Food Processor Course: <br />Attach food handler certification for owm <br />Environmental Health Department <br />3. Products: <br />Provide a list of all products you are preparing, <br />ingredients (attach separate page if needed). <br />Food List: <br />P\oav\ ___ <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 /> “Class Bn (Direct & Indirect Sales) $486 <br />Ono Initial if you agree to abide by the following: 'M <br />Foods containing cream, custard, or meal^£9’g.^^appro^for’preparation by a Cottage Food Operation. <br />XToodTrn"^^^^ to keep them safe from bacterial 9rowth that be a <br />cause of food-borne illness. <br />SANJOAQUIN <br />? Lr.lr.r —COUNTY— <br />Greotness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />registration/permitting renewal form <br />Date: <br />Websjte (If applicable):Telephone.^ - <br />1. Categories: <br />-Class A" (Direct Sales Only) $186 <br />If preparing jams, jellies, or fruit butters include a list of <br />P.(nn/iJVLm Rnk Wifey) <br /> <br />--------------------- <br />r)lA\A€C RnVlS------------------------ -----------------------