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Environmental Health Department <br />COTT AtIF FO(X) OPERATIONS (CFO) <br />REGISTR ATION/PERMITTING FORM <br />r. 4 fr011iflA iMilairMADF r 000 ACT AR 1616 (GATTO)) <br />*1110••re I <br /> <br />0.04, <br />1 1 2 -- _ <br />cro riy <br />?„(fi <br />t41- <br />rawli•-ek rilriomp If t •, opv, <br />A , I LA 4- ‘,/ „ <br />41110Ver. Welostiitt, orgilt.-2414e, <br />-e <br /> <br />Ginieniiit <br />1111 I )01%••• %MO. (My yoF <br />n Ctasc 13- (Direct & Indirect Sales) $312 <br />F!rotobistiomst Initial if you agree to abide by the followincr' <br />iwor ,,-),It•wwnv. mon% custard. re. most fillings are potentially hazardous and are NOT ALLOWED. Only foods rho aft egsforer et ''ricipra-put•reholly hArardouc. are approved for preparation by a Cottage Food Operation. These <br />kyr* trw1441411 $o!"*“ fttai sir fwY rvi(JutrP ref figerat,Con to keep them safe from bactenal growth that could be a cause of sorseHinefw ibewoof <br />'Ilinsik*I Cartlfication Checklist <br />tx,nvmeise (-Gast A CFOs Only) <br />4 !MINK <br />riarop awe 0* awn* yotI Will be preparing and/or selling <br />a Wean Wm. Li Dried Pasta 0 Honey lie PcPc°ffil Popcorn Balls a (AllnaY n Dry Biking Mixes 0 Mustard 0 Vinegar <br />(411114.11 iii Warne Cones 0 Dried Grain Mixes 0 Fruit Butter" <br />11Isuaesusieri, <br />il-reserigftwift s 1:4"1"1" . 0 Flat Icing U r-i Ground <br />Chocolate <br />Ow Maio Moir rj Notanipso• Blends 11 P4291116 II Jams/Jelhes" <br />tj Hum fortparmaes in Flog Tamalee/Piee 0 Nut Mixes/Nut Fried or Baked <br />Donuts and Butlers <br />Waffles <br />sig, Oranaloter` ea* 0 Seasoning UN 0 Trail Mix/ Dried Fruit 0 Dried Fruit <br />0 Colton Candy 111 Candied Apples II Balled Marshmallows/ <br />udge III Marshmallow Caramel/F <br />OM' Bars* <br />001 <br />4105 E Hanlon Avenue 1 &mason, California 08205 I T 209 488-34201 F 209 464-0138 1 vA•Av.sjgov.org/ehd <br />1111.1111111Eirr