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l <br />SAN. JOAQUIN <br />COUNTY— <br />t.�entncs grows here. <br />6ehyorate� L. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO P��hyy�siml Addresh t�'• I (�LL,r,ry� CFO City 22 <br />— 53V, TW6 STr'.m,�- U�)60 CFO Zip J <br />Website (I(applicable): Tele!§t'ne: �;OI 7 q1 <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 <br />r <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. my 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 -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 ❑ Dried Pasta ❑ Honey <br />❑ <br />Candy <br />❑ <br />Churros <br />❑ <br />Buttercream <br />❑ <br />Frosting/Icing` <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dry Baking Mixes <br />Waffle'- <br />❑ Buttercream <br />Fondant/Gumpaste <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Pizzeles <br />❑ Nut Mixes/Nut <br />Butters <br />El <br />Popcorn Balls <br />Popcorn <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter" <br />L1 <br />Chocolate Chocolate <br />❑ <br />Jams/Jellies" <br />Ffied eP Baked <br />Donuts an'3'� <br />Waffles <br />❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />Marshmallows/ <br />Salted <br />13CaramellFudge ❑ Marshmallow <br />Bars' <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 />