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Business SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sFcehd.com COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) N Date: -Icl- 2-2- CFO Z CFO Physical Address: CFO City: CFO Zip: IqQ q N . ri, Website (If applicable): 1. Categories: Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 2. Prohibited Items: Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food -borne illness. 3. "Class A" Self Certification Checklist: ❑ Checklist completed ("Class A' CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. Baked Goods ❑ Dried Pasta ❑ Honey ❑ Candy ❑ Churros ❑ Buttercream Frosting/Icing* ❑ Dried Mole Paste ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Cotton Candy ❑ Dry Baking Mixes ❑ Waffle Cones ❑ Buttercream Fondant/Gumpaste* ❑ Herb/Spice Blends ❑ Fruit Tamales/Pies ❑ Seasoning Salt ❑ Candied Apples ❑ Mustard ❑ Dried Grain Mixes ❑ Flat Icing opcoml Popcorn Balls ❑ Vinegar ❑ Fruit Butter** ❑ Ground Chocolate ❑ Pizzeles ❑ Jams/Jellies** Fried Baked Fried El Mixes/Nut ❑ s Donuts and Butters Waffles ❑ Trail Mix! Dried Fruit ❑ Dried Fruit ❑ Salted Caramel/Fudge Marshmallows/ ❑ Marshmallow Bars* EHD 16-27 6/27/22 1 CFO REG/PERMrr rING FORM