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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ` ; a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:Www.sicehd.com <br /> tN RON T SERVICES TH -- <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMA E D ACT AB 1616 (GATTO)) <br /> CFO Business Name: - r e; Hate: <br /> CFO Physical A dress: CFO O Zip: <br /> 3(e)k <br /> Website(If applicable): Telephone:;(,) (82:7—V( 40 <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $133 ❑ "Class B" (Direct & Indirect Sales) $265 <br /> 2. Prohibited Items: Initial if you agree to abide by the followin ak <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are'NOT ALLOWED. <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 A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ PopcoPnl <br /> Popcorn Balls <br /> �C I. Candy ❑ Dry Baking Mixes ❑ Mustard <br /> . ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream Buttercream Ground <br /> ElFrostingllcing* ❑ Fondant/Gumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried,Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ JamslJellies** <br /> ❑ Fruit Em anadas ❑ Nut Mixes/Nut Fried or Baked <br /> p ❑ Fruit Tamales/Pies Butters ❑ Donuts and <br /> Waffles <br /> ❑ <br /> Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit <br /> �v ❑ Dried Fruit <br /> ' Y Marshmallows/ <br /> ❑ Cotton Candy :E;.❑ Candied Apples ❑ Salted <br /> Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> '1r I <br /> EHD 16-27 8!12116 CFO REG/PERMITTING FORM <br /> f JJJ <br />