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SAN _J Q A Q U IN Environmental Health Department <br /> _ C0UNT`r -_ _ <br /> COTTAGE FOOD OPERATIONS (CFO) FFe 2 12019 <br /> REGISTRATION/PERMITTING FORM 'ENVIRONMENZgL <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) PERMIT/SERVIC SLTH <br /> CFO$ugin_essNan)V' � acu Ov�p r�NJ\1� Date:A��20I ' 1 <br /> CFO�Physical Address: CFO City: CFO Zip: <br /> Website(If applicable): Telh�ne: <br /> -it Cate <br /> Y_ "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: <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. `lass 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 /> �yJ, Baked Goods El Dried Pasta El Honey El Popcorn/ <br /> 7-' Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercrearnj Buttercream Ground <br /> Frosting/Icing* ff"' Fondant/Gumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ El Donuts and <br /> Butters Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ElDried <br /> Soup Mixes F-1 Vegetable and Potato Chips <br /> 1868 E. i-lazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />