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P�_0SI+-1 --T i2 <br />SAN J O A Q U I N Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Neme: Date: <br />CFO Physical Address: CFO City: CFO Zip: <br />1315-3o Qu�-t r.J r�4 X33 <br />Website (If applicable): Tele ho e: <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 O D. 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 <br />Ell' Candy <br />❑ Churros <br />ElButtercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />12 Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />Dry Baking Mixes <br />❑ Waffle Cones <br />❑ Buttercream <br />Fondant/Gumpaste* <br />0' Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />Seasoning Salt <br />❑ Candied Apples <br />❑ <br />Honey <br />❑ <br />Mustard <br />❑ <br />Dried Grain Mixes <br />❑ <br />Flat Icing <br />❑ Popcorn/ <br />Popcorn Balls <br />L?�Vinegar <br />❑ Fruit Butter** <br />❑ Ground <br />Chocolate <br />❑ Pizzeles <br />❑ <br />Jams/Jellies" <br />Fried or Baked <br />Nut Mixes/ ut <br />El <br />Donuts and <br />e <br />Waffles <br />Trail Mix/ Dried Fruit <br />dried Fruit <br />Salted <br />Marshmallows/ <br />❑ C <br />Caramel/Fudge <br />L1 <br />Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/ehd <br />60 <br />