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SAN -10 A Q U I N Environmental Health Department <br /> CC)ur,i <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: D te: <br /> r,;e�t C{umhl� z ��l�� S�rer�e- L� ,e-e, j7� <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Website(If applicable): Telephone: <br /> acv IQ <br /> 1. Categories: <br /> -Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales) $310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: J` <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> 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 2 Popcorn/ <br /> Popcorn Balls <br /> [ Candy Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes Fruit Butter"' <br /> Ql Buttercream U/Buttercream �' Flat Icing ❑ Ground <br /> Frosting/Icing Fonda nt/G um paste* Chocolate <br /> ❑ Dried Mole Paste Qom/Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies'"" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas Q' Fruit Tamales/Pies Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy Candied Apples Caramel/Fudge `r Marshmallow <br /> Bars <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ElDried <br /> Soup Mixes E] Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br />