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oP"4 " SAN JOAQUIN COUNTY <br /> ' <'I ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sacehd.com <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: _ Date: y <br /> �(ihnQaly'� P-P�D�I1(9� YttYlY1j. e -nYqyi(10 lo- Z3- )y- <br /> CFO Physical Address: CFO City: CFO Zip: <br /> �`4 �3 "13s id�seDo�� la 1 r(-nn-I-ce_ qS33(p <br /> Website(If applicable): Telephone: <br /> 1. Catecaories: <br /> 4 "Class A" (Direct Sales Only) $146 ❑ "Class B" (Direct& Indirect Sales) $292 <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 AL OWED. <br /> Only foods that are defined as"non-potentially hazardous'are approved for preparation by a Cottage Food <br /> Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br /> growth that could be a cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> Checklist completed ("Class X CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> Candy Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream Buttercream Ground <br /> Frosting/Icing* Fondant/Gumpaste. El "Flat Icing Chocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ Pizzeles Jams/Jellies** <br /> la <br /> �t Nut Mixes/Nut Fried or Baked <br /> F-1FruitEmpanadas Fruit Tamales/Pies gutters El Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> �{ Salted �5 Marshmallows/ <br /> ❑ Cotton Candy Candied Apples KY a Caramel/Fudge Marshmallow <br /> Bars* <br /> EHD 16-27 7/27/17 1 CFO REG/PERMITTING FORM <br />