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aRsxr"' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 APR Q <br /> fpaw�' Telephone:(209)468-3420 Fax.(209)464-0138 Web:wwwsicehd.c�V/ 2ROV1 2018 <br /> COTTAGE FOOD OPERATIONS (CFO) PFRMMS�R�C Stly <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business <br /> Name Oner Name:lSU nwPC /0,_5 SInG0- ;/ LJAAY / ! Date:f <br /> CFO Ph I Address: FO City: CFO Zip: <br /> 09t/D (AIILPb glZy IJJ C(G�0 95,U9 <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> [21 "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: <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-bome 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 /> NJ Baked Goods ❑ Dried 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 E] 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 ❑ Fruit Tamales/Pies ❑ gutters E] Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> F-1 Catton Candy ❑ Candied Apples ❑ Caramel/Fudge ElMarshmallow <br /> Bars* <br /> EHD 1627 2/3117 1 CFO REGIPERMITTING FORM <br />