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SAN J O AQ U I N Environmental Health Department <br /> -- COUNTY— <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REG ISTRATIONIPERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> FO Business Name: Owner Name: ate: <br /> S -ell t5 S SkA Sl y '� , $t I! 6et�r • 13 o 2 <br /> CFO Ph cal Addre : CFO City: CFO Zip: <br /> 5M 15- <br /> Website(If applicable): Telephone: <br /> qv'��4', <br /> 1. Categories: <br /> K "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: 5� <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 /> R Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Popcorn/ <br /> 9 Baked Goods ❑ Dried Pasta ❑ Honey �Q Popcorn Balls <br /> R Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> R Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter*" <br /> ® Buttercream ® Buttercream ❑ Flat Icing ❑ Ground <br /> Frosting/Icing* Fendant/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 />