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r4A-AjI <br /> SALMON Environmental Health Department <br /> COUNTS - <br /> (:ASV-\b1 vSSom I�r,,�uy C� <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM may) <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> Ask Rlossorn l3akeru baiie% Poole _Ijgl,2022 <br /> CFO Physical Address: CFO City: CFO Zlp: <br /> 4o2 Quaj IZun C1rcje Traces 15-377 <br /> Website(If applicable): Telephone: <br /> {1-f4S, U09) 7 - 057 <br /> ask -�, rsse^+- baker+ <br /> 1. Categories: <br /> 4 "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: p <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 /> Ca Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ® Baked Goods ElDried Pasta ElHoney ❑ Popcorn/ <br /> Popcorn Balls <br /> 0 Candy [4 Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> H Buttercream isiButtercream ® Flat Icing ❑ Ground <br /> Frosting/Icing* Fonda nt/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/NutFried or Baked <br /> F-1 FruitEmpanadas ElFruit Tamales/Pies ElButters ElDonuts 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- <br /> 11 Vegetables ❑ Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD <br />