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SAKAAQUIN Environmental Health Department <br /> —COUNTY— <br /> °ai, P Greotness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO). <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Busines Name: (. Owner Name: <br /> 7 Date: <br /> l) FSS 7t�Ylt ClgraQ114` f " fP_I i 5,5A Loc, 11 / 11 <br /> CFO Physical Address: CFO City: CFO Zip: .. <br /> N (- CQ O CI '--)Ll(—(073-7 <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155 0CIassB- ( irect& Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: 1-4/ L. <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 items you will be preparing and/or selling. <br /> 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 Ground <br /> ElFrosting/Icing* E] [3[3 Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empariadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> Ll Cotton Candy El Candied Apples ❑ ❑ <br /> Caramel/Fudge Marshmallow <br /> Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables E] BasedSoup Mixes E3 Dried and Potato Chips <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 i T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />