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SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> a <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO BusJ'/'ess Name: Owner Name: F Dat : -7 <br /> :>Z3 <br /> 2l� Y Iafn� I`1G,.tCiL. �G✓'cX I�VSa� �L f'5��/ 3o�vc�r <br /> CFO Physical Address: CFO City: CFO Zip). <br /> 36773 S 'Itc-cy Btu, �_I_r '15377 <br /> Website(If applicable): Telephone: <br /> 1. Cateqories: <br /> ❑ "Class A" (Direct Sales Only)$186 71 "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 ElDried Pasta ElHoney ElPopcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream ❑ Flat Icing ❑ Ground <br /> Frosting/Icing Fondant/Gumpaste Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ff?Z Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ gutters El Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />