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P <br /> SAN ..JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'cehd.com. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name(�, 1 Owner Name: Date: <br /> 114 CFO Physical Address: CFO City: CFO Zip: <br /> 3120 1 2-!S)-7 <br /> Website(If applicable): Telephone: / <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 following: 6611 <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 ❑ Popcorn/ <br /> Popcorn Balls <br /> L2 Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercreamuttercream Ground <br /> * [� Flat Icing El <br /> Fondant/Gumpaste _— Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> SaltedMarshmallows/ <br /> ❑ Cotton Candy E] Candied Apples ElCaramel/Fudge Marshmallow <br /> Bars* <br /> EHD 16-27 8/12/16 1 CFO REG/PERMITTING FORM <br />