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SAN JOWIN Environmental Health Department <br /> — COUNTY <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) (� <br /> Ir vv rr <br /> CFO B sI � TCF : <br /> ame: a1e_l / 2 <br /> CFO <br /> :F P ysical Address: ' �_/ ����� r1(nG /� L('//1 <br /> Website p,l pplicableyc , ' ^ , r-�c`-`.-- -(Ik ph• - _ " 1 l(/ <br /> 1. Categories: <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. �r I <br /> =nods 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 andlor selling. <br /> Popcorn/ <br /> ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn Balls <br /> ] Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter' <br /> ❑ Buttercream ❑ Buttercream ElFlat Icing El 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 ❑ Butters Donuts and <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 Oars' <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- <br /> Vegetables Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138I www.sjgov.org/EHD <br />