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SAN JOAQUIN —COUNTY— . G,entnrss grows here. CFO Business Name:. CFO Website (If applicable): I\ew- nee VQ Environmental Health Department COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) 1. Categories: "Class A" (Direct Sales Only) $186 CFO City: Date: �tGe_r o31�0�23 CFO ❑ "Class B" (Direct & Indirect Sales) $312 2. Prohibited Items: Initial if you agree to abide by the following: QQ 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-bome illness. 3. "Class A" Self Certification Checklist: ❑ Checklist completed ("Class A" CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcom/ Popcorn Balls [Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** ❑ Buttercream11Buttercream El Flat Icing El Frosting/Icing* Fondant/Gumpaste' Chocolate Chocolate ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Nut Mixes/Nut ❑ Fried or Baked Donuts and Butters Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow Bars* 1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd _.� P?205q 9 318 _1� S