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SAN J O A Q U I N Environmental Health Department <br /> COUN—v <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner. ame: Data: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 134 *-kg4l,, � T/-.?0-y gS3P1� <br /> Website(If applicable): Telephone: <br /> IGS$ -jOly �'�f3s <br /> 1.. /Categories: `.pe- <br /> i� "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 \J-9—t ' <br /> 7 2. Prohibited Items: Initial if you agree to abide by the following(Z:! <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) 1 P5 2- <br /> _ v� <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> (� Baked Goods ❑ Dried Pasta El Honey El Popcorn <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream ElFlat Icing ❑ Ground <br /> Frosting/Icing"' Fondant/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/NutFried or Baked <br /> ❑ Fruit Empanadas E] Fruit Tamales/Pies E] 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 />