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—..t SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sicehd.@em, <br /> COTTAGE FOOD OPERATIONS (CFO) pFRMMSF"?V/C, 4qtq <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Omer Name: Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> /yZy W LOCUS-� Loaf t , KA ySZyZ <br /> Website(If applicable): Telephone: <br /> aO9 152 - 57(o (0 <br /> 1. Categories: ,,1, <br /> ��yv 2_1q Z. <br /> g "Class A" (Direct Sales Only) 3 ❑ "Class B" (Direct& Indirect Sales)$2155 <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. <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 /> F-1Baked Goods ElDried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> ❑ Buttercream ❑ Buttercream ❑ Flat Icing ❑ Ground <br /> Frosting/Icing* Fondant/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas El Fruit Tamales/Pies 11ElElDonuts and <br /> 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 /> EHD 16-272/3/17 1 CFO REG/PERMITTING FORM <br />