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COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AS 1616 (GATTO)) CFO Business Name: Owner Name: Date CFO Physical Address: CFO City: CFO Zip: /Hl"( W Ge, t Sf Ge D, CA Website (If applicable): Telephone: )09 575 4:() 1. Categories: '] "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 V,4 Re nfw�i 2. Prohibited Items: Initial if you agree to abide by the following: �t� Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food -borne illness. 3. "Class A" Self Certification Checklist: t`� Checklist completed ("Class A" CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/Popcorn Balls ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" ❑ Buttercream ❑ Buttercream ❑ Flat Icing El Ground Frosting/Icing' FondanUGumpaste' Chocolate ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies'- Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Nut Mixes/Nut ❑ Fried or Baked Donuts and Butters Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallowsi L, Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow Bars' ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips Vegetables Based Soup Mixes