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SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows hen- <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> ^(CALIFORNIA HOMEMADE FOOD ACT <br /> �/A'�(B� 1616 (GATTO)) ,t .7 � <br /> CF Usines ���C� W\ \nJ��y � �`Y 1�1 (CSS II tel2Tl 024 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> ,E�)(kl -Tv aaa S+ wa dcte/ qSd <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> Q9 "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct&Indirect Sales) $310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: Ob-i <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of food-bome illness. <br /> 3. "Class A" Self Certification Checklist: <br /> DQ Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> I$ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter— <br /> El <br /> utter—❑ Buttercream ❑ Buttercream E] Flat Icing ❑ Ground <br /> Frosting/Icing` Fondant/Gumpaste` 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />