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Pciuiti,�c\. <br /> ,. 01S AN J O A Q U I N Environmental Health Department <br /> " s COUNTY-- <br /> a'" Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: O er Name: I I Date: <br /> I {err)gr7de.L rDJO(P c�r� r t- renandLZ <br /> CFO(VII <br /> Physical Adpress:l-. ! I CFO City: LU, k � �Zip: <br /> Website(If applicable): Telephone: <br /> Qv�Cr PNrniW � h ► 1 ► ICm I :2aW U 2L - (aI� U3 <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: <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 /> ❑ Baked Goods ❑ Dried Pasta Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> Q Candy ❑ Dry Baking Mixes ❑ Mustard ElVinegar <br /> F-1Churros F-1Waffle Cones N/Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream El Flat Icing ❑ Ground <br /> Frosting/Icing* Fonda nUGumpaste* Chocolate <br /> ❑ Dried Mole Paste [ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried s Baked <br /> ❑ Fruit Empanadas El Fruit Tamales/Pies Butters ❑ Donuts and <br /> / Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt Trail Mix/ Dried Fruit IIN 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 209 464-0138 1 www.sjgov.org/EHD <br />