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SAN J O A Q U I N Environmental Health Department <br /> �,IJ N_Y <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO BusinessName <br /> d : Owner Name: Date: <br /> 1_ <br /> CFO Physical Address: CFO City: CFO Zip: <br /> JJ,C�nn 1� i Q Wall �Y:y6VX& <br /> Website(If applicable): Tel <br /> 1�,�15q Iy�2 <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $312 <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-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 El Honey El Popcorn <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes <br /> ❑ Fruit Butter" <br /> �¢ Buttercream Buttercream ❑ Flat Icing El ng <br /> Frosting/Icing" �l Fonda nt/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles <br /> ❑ Jams/Jellies" <br /> ❑ Fruit Em anadas Nut Mixes/Nut Fried or Baked <br /> p ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit <br /> ❑ Dried Fruit <br /> El Cotton CandySalted Marshmallows/ <br /> ❑ Candied Apples ❑ E] Marshmallow <br /> Caramel/Fudge Bars" <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />