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f <br /> SKJOAQUIN Environmental Health Department <br /> ---CC)UIVTY - - <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> i <br /> f �C'F�O�B"u�si.n�ens�s Na e: vmer Neme: Date: <br /> f EIIID1_� fZoaCl Enry) c InG3sefI <br /> CFO Physical Addres : CFO City: CF Zi <br /> Website(if applicable): Telepho e: <br /> 1�/Categories: <br /> µf "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;/y/j 2 <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NO LL—OWED. 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 /> 1 <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 /> N 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 ❑ ButtercreamEl Flat Icing El Chocolate Frosting/Icing" Fondant/Gumpaste" Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies•• <br /> ❑ Fruit Empanadas Fruit Tamales/Pies ® Nut Mixes/Nut Fried or BakedButters ❑ 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 /> El Vegetables <br /> or Dehydrated E) Dried Vegetarian- El 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 209 464-0138 1 www.sjgov.org/EHD <br />