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f\QA,.) - r\_Q9 t�� P�2 SAN JOAOUIN Environmental Health Department —court c. -SS COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO 0()UCName 1I : �� Owner Na�p��dra Date: i/,L`' CFO Physical dress: CFO City: J CFO Zip: i `I If Website(If ap lic 61 Telephone: //^^ ill l 1. Categories: "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales) $310 2. Prohibited Items: Initial if you agree to abide by the following: 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: 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 El Flat Icing El Ground Frosting/Icing* Fondant/Gumpaste* Chocolate ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut Fried or Baked ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ ❑ Donuts and Butters Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑ Candied Apples ❑ El Marshmallow Caramel/Fudge Bars* Dried or Dehydrated Dried Vegetarian- ❑ Vegetables ❑ Based Soup Mixes El Vegetable and Potato Chips 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/EHD