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Poll% <br /> SAN JoAQuiN <br /> Environmental Health Department <br /> COUNTY <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> Si a - - <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1��_- Kton gsa�2 <br /> Website(If applicable): Telephone: <br /> -79 -29?, <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155 EK "Class B" (Direct& Indirect Sales) $310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> T <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. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the iterns you will be preparing and/or selling. <br /> Baked Goods ❑ Dried Pasta ElHoney ElPopcorn/Popcorn Balls <br /> Candy Eg' Dry Baking Mixes Eg' Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones [�l Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream Buttercream Ground <br /> El Buttercream <br /> El Fondant/Gum paste* El Flat IcingChocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried 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 /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> Dried or Dehydrated IV Dried Vegetarian- E91"'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 />