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SAN JOAQUIN Environmental Health Department —COIJN-Y— COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: CFO Physical Address: _ 1cN IC/1Y1 wq We ite (If applicable): V)" �S 1. Categories: X"Class A" (Direct Sales Only) $186 Owner Name: �G1 CFO City: Date: bs 0112-12022- CFO 112-2022CFO Zip: - 401,-b32- -7g 22 ❑ "Class B" (Direct & Indirect Sales) $312 2. Prohibited Items: Initial if you agree to abide by the following: -i— L 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/orselling. ❑ Baked Goods ❑ Dried Mole Paste ❑ Dried Pasta ❑ Candy El Churros ElButtercream Frosting/Icing' ❑ Dried Mole Paste ❑ Dried Pasta ❑ Dry Baking Mixes ❑ Waffle Cones ElButtercream Fondant/Gumpaste* ❑ Herb/Spice Blends ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Granola/Cereals ❑ Cotton Candy ❑ Seasoning Salt ❑ Candied Apples El El Popcorn Popcorn Balls ❑ Mustard ❑ Vinegar ❑ Dried Grain Mixes ❑ Fruit Butter— utteP'❑ El Flat Icing ❑ Ground Chocolate ❑ Pizzeles ❑ Jams/Jellies" Nut Mixes/Nut Fried or Baked ❑ Butters ❑ Donuts and Waffles ❑ Trail Mix/ Dried Fruit Dried Fruit Salted Marshmallows/ ❑ Caramel/Fudge 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 oc6