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SAN:JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> • y � <br /> Greamess grows here. I <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616(GATTO)) <br /> I <br /> CFO Business Neme: Owner Name: bate: <br /> (�a the SeeAp u f 51 N E l�gEA11 tN /19cDaHi1P� <br /> CFJc2LL dd/re�s/s�:/ beg��� /��FO Ciry: CFO Zip: -33L <br /> Website(if applicable): " Telephorre: ^ /�—ZZ0R 9 <br /> 1. Categories: j <br /> CDirect Sales Only)$155 ❑ "Class B"(Direct&Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> G <br /> Foods containing cream, custard,or meat fillings are potentially hazardous and are NOT ALLOWED. Only j <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 bactedal growth that could be a <br /> 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 /> Baked Goods ❑ Drled Pasta ❑ Honey ❑ Popcorn/ <br /> PopcomBalis <br /> ❑ Candy ❑ Dry Baking Maes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> ❑ Buttercream ❑ Buttercream [3 Flat Icing ❑ Ground <br /> Frosting/icing' FondanttGumpasta Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters 11 Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ CaramellFudge ❑ Marshmallow <br /> Bars' <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue 1 Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br /> I <br />