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SANJOQQUIN Environmental Health Department <br /> —COUNTY— <br /> Greotness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> (CFO Business Name Pny��,1I4 pti1pptl�tpe'3 5 Owner Name:: Date: <br /> CFO Physical Address: CFO City: CFO Zip: *6 <br /> Lam_ <br /> Website(If applicable): Telephone: <br /> 1. Cate ories: <br /> "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: IWL <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 /> dBaked 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 /> dButtercream d Buttercream d Flat Icing ❑ Ground <br /> Frosting/Icing` FondanUGumpaste' Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies <br /> ❑ Nut Mixes/Nut dFried or Baked <br /> Butters nd <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> ❑ Salted Marshmallows/ <br /> Cotton Candy ❑ Candied Apples ❑ ❑ Marshmallow <br /> Caramel/Fudge Bars` <br /> ❑ Dried or Dehydrated Dried Vegetarian- <br /> Vegetables ❑ Based Soup Mixes ❑ 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 />