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SAN JOAQUIN Environmental Health Department COUN—Y— COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) Omer Name: Date: CFO Physleal Address: CFO City: v CFO Zip: 6 --ID ((rt11'Ii� (oral Website (If applicable): Telephone: :;)©g -z-1)-61 >a n 1. Cate-gories: "Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 2. Prohibited Items: Initial if you agree to abide by the following: Mn 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: PR Checklist completed ("Class A" CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. F1 Baked Goods El Dried Pasta E] Honey El Popcorn Popcorn Balls ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** E]Frosting/Icing* Buttercream ;�7qq Buttercream El Flat Icing ElChocolate Ground Y Fondant/Gumpaste* ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** F-1 FruitEmpanadas ❑ Fruit Tamales/Pies Elgutters Nut Mixes/Nut ❑ Fried or Baked Donuts and Waffles Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge El Marshmallow Bars* 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd ffm$06 1 S