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r <br /> SANLIQAQUIN Environmental Health Department <br /> —COUhITY— <br /> Greotness grew: here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name`:, 1 <br /> Ca�trolk- - 2�4cr5 LI�4 flp V��adtL n8Z7.2- <br /> CFO Physical Address: CFO City: CFO Dp: <br /> Lilo ?,?t r. Cwdke Tv-;�c, M-Uv <br /> vvebstte(M applicable): Telephc4. <br /> 1. Catenories: � <br /> ER 'Class A"(Direct Sales Only)$155 - r/ Class B'(Direct&Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: L-V, <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br /> foods that are defined as'non-potentialy 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-home illness. <br /> 3. "Class A" Self Certification Checklist <br /> Ej 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 ❑ Popm Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter' <br /> ❑ FotingeAc ng• ❑ Fondan Gumpaste' ❑ Flat Icing ❑ Ground <br /> Chocolate <br /> ❑ Dried Mole Paste ❑ Herbispice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut MixesMut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Grarsola/Cereals ❑ Seasoning Sal ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Marshmallows/ <br /> Salted <br /> ❑ Cotton Candy C3 Candied Apples ❑ Caramel Fudge ❑ Marshmallow <br /> Bars <br /> ❑ bbhydrated ❑ Driedixes ❑ Vegetable and Potato Chips <br /> 1868 E Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/EHD <br />