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SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> i, <br /> r>': (ire ctne,sgroins here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business I Owner Name: Date: <br /> Name: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> !C6-II QST t+ IZ Lit 66 g52gU <br /> Website(If applicable): Telephone: <br /> rte - 2�1 ' 32r y4�z- <br /> 1. Categories: <br /> X "Class A"(Direct 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 /> ❑ Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> /Please check the items you will be preparing and/or selling. <br /> Dg. Baked Goods E3Dried Pasta El Honey El Popcorn/ <br /> Popcorn Balls <br /> 51 Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros� ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> ❑ Buttercream * ElButtercream * E] Flat Icing ❑ 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 ❑ Fruit Tamales/Pies ❑ gutters ❑ 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 [1 Marshmallow <br /> Bars* <br /> Dried or Dehydrated❑ Dried Vegetarian- <br /> Vegetables ❑ Based Soup Mixes E] Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />