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SKJOAQUIN Environmental Health Department <br />Com' A'—COUNTY— <br />Greatness <br />'—COUNTY—Gre'UtrlE55 dere. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />}o� n ,ne's Geo j�- <br />CFO Physical Address: <br />to n L r.t.. Q nco 1n�G <br />Name: t ( Date: <br />UA -ti kcA CkAvw, 06a�- <br />CFO City: <br />Website (If applicable): lletp�h S <br />e� C, <br />CFO Zip: <br />1. Categories: <br />®' "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 <br />S aog <br />2. Prohibited Items: Initial if you agree to abide by the following: FC - <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 />❑ Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />❑ Baked Goods <br />❑ <br />Candy <br />Ir <br />Churros <br />ElButtercream <br />Popcorn <br />Popcorn Balls <br />❑ <br />Frosting/Icing* <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />EI <br />Dried Pasta <br />El <br />Honey <br />El <br />Popcorn <br />Popcorn Balls <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />❑ <br />Buttercream <br />❑ <br />Flat Icing <br />❑ <br />Ground <br />Fondant/Gumpaste <br />Chocolate <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />Fried or Baked <br />(� Donuts and <br />Butters <br />Waffles <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />ElCandied <br />Apples <br />❑ <br />Caramel/Fudge <br />E] <br />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 95206 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />