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SAN JOA 0 U I N Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) V—T 1 'Z <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> O 6u ness")n, <br /> 4 Owner Name oale nl�,a�2D2rL <br /> anoo�p ><cxen !ss! Pame/a <br /> CFO Physa 1 Address CFO Gly CFO Zip <br /> lagy )<0444W /eon 77"aey 76 <br /> Website QfappbcaEkl Telephone 4pg _ 34 - 2135- <br /> 1. Categories: <br /> ❑ -Class A"(Direct Sales Only)$186 -Class B"(Direct&Indirect Sales) 5312 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> Foods containing cream,custard,or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br /> that are defined as 'non-potentially hazardous"are approved for preparation by a Cottage Food Operation. These <br /> foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br /> food-bome 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 andlor selling. <br /> Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter^ <br /> ❑ Buttercream ❑ Buttercream C1 Flat Icing ❑ Ground <br /> Frosting/Icing' Fondant/Gumpaste' Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ JamsiJellies" <br /> ❑ FruitEmpanadas ❑ Fruit Tamales/Pies ElNut Mixes/Nut Fried or BakedButters ❑ 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 /> 1868 E. Hazellon Avenue I Stockton,California 95205 1 T 209 488-34201 F 209 464-0138 1 www sjgov orgfehd <br />