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4 , <br /> SAN JOAQUIN COUNTY <br /> ' _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ._ y Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s ov.org/ehd <br /> ��wap <br /> -COTTAGE FOOD OPERAT-IONS (CFO) <br /> REG ISTRATI0NIPERMITTING,FORM <br /> } (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: - Date: <br /> CN i� N <br /> CFO Physical Address: CFO City: CFO Zip: ¢ <br /> Website(if applic2ble): ' x " Telephone: <br /> a 9 �.6q)- s . . <br /> 1. Categories- <br /> "ClassA'°.(D.irect Sales Only) $125r� ;`Class B",(Direct& Indirect Sales) $250,.' <br /> 2. Prohibited Items: ;; Initial if you agree to abide by the following: <br /> Foods containing cream,:custard;olr m eat fillings are potentially hazardous and are'NOT ALLOWED, <br /> Only foods that are defined as"non-potentia[ly 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-tbo`cne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> u. ,4:r <br /> ❑ Checklist completed ("Class A" CFOs Only) <br /> EI. Products:.,,, <br /> Please check the items you.will he preparing andlor selling.=_ . <br /> ® Baked Goods. ❑ Dried Pasta, .j, ❑ Honey : . Popcorn . <br /> F-1Candy j. ; ❑, Dry. Baking+ '❑ <br /> Mixes ,kF.Mustard, ❑ Vinegar, ,. <br /> Churros ,+ ❑.. hWaffle Cones Tortillas ❑. Fruit Butter" <br /> ❑ Dried Mole Paste ❑x HerblSpice Bends ` ❑' 'Pizzeles JarnslJellies** <br /> 14 Fruit Empanadas Fruit Tamales/Pies ❑ NutslNut Mixes ❑ Dried Fruit <br /> ❑ Granola/Gereals ❑ Nut Butters ❑ Dried Tea ❑ Trail mix <br /> ❑ Sweet Sorghum0 a Roasted Coffee'" f `"=Chocolate Covered'Nonperishable Food <br /> Syrup F . . ., 10 <br /> ❑ Other: <br /> These items must comply with standards described in Part 150 of Title 21 of the Code of Federal Regulations <br /> htt :liwww.accessdata.fda. ov/scri tstcdrhtcfdocs/cfCFRICFRSearch.cfm?CFRPart=150 <br /> EHD 16-27 1/6/2014 1 CFO REGtPERMITrIHG FORM <br />