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� �Aa � � � Environmental Health Department <br /> --COUNTY-- <br /> COTTAGE FOOD OPERATIONS (CFO) JUL 22 2p7l <br /> (CALIFORNIAREGISTRATOMEMIAODEFOOD ACT AB FORM <br /> (GATTO)) EN PI RM�SRRVICLTH <br /> ES <br /> CFO Business Namey-1, ,e, // �„j n 6�` Owper Name: 6 hart j1e_� _ / Dat7/1/Z / <br /> ed//1/�'J <br /> CFO Physical AddresVsi//Wi]U I IJ�' t�'`L(cl:F..f��7t �" / ��IW�WtLFOZiyi <br /> Website(If applicable): %%11, <br /> Telephone:q^r+ �90 <br /> 1. C to 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: LIU <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 /> O'Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> F-1BakedGoods El Dried Pasta [_1 Honey opc_c <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> ❑ Buttercream * ❑ Buttercream * El Flat Icing E] Ground <br /> Frosting/Icing FondanVGum paste* 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 ❑ 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 j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 ( www.sjgov.org/EHD <br /> ��S I ltoo S <br />