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t , <br /> SAN J 0 A Q U I N Environmental Health Department <br /> j <br /> _.... _..C O U N T Y�------ <br /> Greatness graves here, <br /> COTTAGE FOOL OPERATIONS (CFO%) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: / , Date: <br /> Ll�LGr2 <br /> CFO Ph ical Address: CFO ity: CFO Zip: <br /> Website(If applicable): Telephone: <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: _ <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 /> $, iaa� r► a�99 w�99.iiiva�iv99 �./99K.l.n9i�a. <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 /> LJ candy (J ury baKing mixes U IVlustara LI vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes [ Fruit Butter** <br /> Buttercream Buttercream Ground <br /> ElFrosting/Icing* ❑ Fonda nt/Gumpaste* E] Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles Jams/Jellies'* <br /> Nut Mixes/NutFried 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 /> Salted Marshmallows/ <br /> ❑ <br /> I�Cotton Candy E] Candied Apples ❑ (Vlar-,hrnalln\niCaramel/Fudge <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 ( T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />