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fiA SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:Wwwv_s•cehd.com' <br /> l : <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REG ISTRATIONIPERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> (21 r c V►-i oL P1 r-e 2 f 7 <br /> ``CFO Physical Address: �/�,, O City: CFO Zip: <br /> 1.I'-iC 1a�]Ch6LI+y. Yklain4-4Cfn c�3-] <br /> Website(If applicable): Telephone: <br /> 20 0 -a�S3z- <br /> 1. Categories: <br /> "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-borne illness. A <br /> 3. "Class A" Self Certification Checklist: f <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 /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard E]- Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes' ❑. Fruit Butter" <br /> Buttercream Buttercream ❑ Flat Icing ❑ Ground <br /> Frosting/Icing Fonda nt/Gumpaste Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> F1 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 /> F-1CottonCandy. E] Candied Apples El Salted <br /> E] Marshmallow <br /> Bars <br /> E H D 16-27 213/17 1 CFO REGIPERMITTING FORM <br />