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SAN.JOAQUIN Environmental Health Department <br /> —C QUNTY— <br /> JUL 2 qL2®2'COTTAGE FOOD OPERATIONS (CFO) ENVIROl,,ijWE�. <br /> REGISTRATION/PERMITTING FORM PERMjr/Sj�RV1F1Ek7`l-j <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CES <br /> CFO Business Name; Owner Name: Date'. <br /> CFO Physical Address: CFO City. CFO Zip: <br /> Website(if appli=<jm.� Telephone: <br /> 0 lo– 2-Lk <br /> 1. ///Categories: <br /> Class A"(Direct Sales Only)$155 El "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 bacteria[growth that could be a <br /> cause of food-bome illness. <br /> 3. ."Class A" Self Certification Checklist: <br /> 0 Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Baked Goods El Dried Pasta El Honey Ej Popcorn/ <br /> Popcorn Balls <br /> El Candy Dry Baking Mixes El Mustard ❑ Vinegar <br /> El Churros F1 Waffle Cones 0 Dried Grain Mixes El Fruit Butter** <br /> ❑ Buttercream ❑ Buttercrearn [I Flat Icing El Ground <br /> Frosting/Icing* FondantlGum paste* Chocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends El Pizzeles El Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> El Fruit Empanaclas Fruit Tamales/Pies El Butters El Donuts and <br /> Waffles <br /> 1-1 Granola/Cereals El Seasoning Salt E1 Trail Mix/Dried Fruit 0 Dried Fruit <br /> Salted Marshmallows/ <br /> El Cotton Candy El Candied Apples ❑ Caramel/Fudge 0 Marshmallow <br /> Bars* <br /> El Dried or Dehydrated 1:1 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 /> V ""161q S <br />