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SAN JOAQUIN Environmental Health Department <br /> ----COUN v-- - <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Ovmer Name: Date: <br /> F`ttee-+e Deed Ca <br /> ndies ReA SO 12 -101-21 <br /> CFO Physical Address: CFO Clty: CFO Zip: <br /> 13b 1 2g ( L} MC 1n4?C.J. °1533 <br /> Website(If applicable): Telephone: <br /> (4n�1 �t3o� b3�C <br /> 1. Categories: <br /> ❑ "Class A"(Direct Sales Only)$155 jj, "Class B"(Direct&Indirect Sales)$310 ,,pp�� <br /> 2. Prohibited Items: Initial if you agree to abide by the following: 1U <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-bome 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 ❑ Popcom/ <br /> Popcom Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter'" <br /> I <br /> Buttercream Buttercream Ground <br /> 13Frosting/Icing' ElFondant/Gumpaste' ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas El Fruit Tamales/Pies ElButters El 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- ElVegetable 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 />