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''��`rc�°= SANAOAQUIN Environmental Health Department <br /> "'t � —COUNTY— <br /> equP Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AS 1616 (GATTO)) <br /> CFO Business Name: Owner Date: <br /> �u�f r GIS oc� ho� rbla�, <br /> CFO Physical Add": CFO City: CFO Zip: <br /> X94& Tr�(�s* Q - zl� 95 <br /> Website(Ir applicaMey Telephone: C/o?` <br /> to ones• l <br /> ss A"(Direct Sales Only)$155 ❑ "Class B"(Direct&indirect Sales)$310 <br /> 2. rohibited Items: Initial if you agree to abide by the foNowing: e <br /> Foods containing cream, custard, or meat fillings are patentiafly 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-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 ❑ Dried Pasta ❑ Honey El Dried <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter`" <br /> Buttercream Buttercream Ground <br /> Frosting/Icing' ElFondant(Gumpaste` E] Flat Icing Elelate <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 ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/EHD <br />