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SAN J O A Q U I N Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CBusiness ame: Owner Name: Date: <br /> FO <br /> U C62d! l)(Nm113IQkR 4h _71251202-6 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 113 4 7*h St gym_n %15(4 <br /> Website(If applicable): Telephone: <br /> (2M1(D1(0 <br /> 1. Categories: <br /> "Class All 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 /> 3. "Class A" Self Certification Checklist: <br /> W Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> �y Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes W Fruit Butter' <br /> ❑ Buttercream ❑ Buttercream ❑ Flat Icing El 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 E] Fruit Tamales/Pies Elgutters [71 Donuts and <br /> Waffles <br /> ❑ Granola/Cereals Seasoning Salt ❑ Trail Mix/Dried Fruit I4 Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ElCaramel/Fudge El Marshmallow <br /> Bars' <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.sjgov.org/EHD <br />