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CFO City: ii:ef <br />Telephone: <br />CFO Zip: <br />fs5r/7 <br />SAN JOAQUIN <br />—COUNTY <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />P kq.-1/ /,1 awy <br />Owner Name:6 Date: ti <br /> <br />CFO Physical Address: <br />//q71 63 4_0( g/e_ <br />Website (If applicable): <br />1. Categories: <br />El "Class A" (Direct Sales Only) $186 N1 "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: <br /> <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 />"Class A" Self Certification Checklist: <br />0 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 Baked Goods El Dried Pasta 0 <br />E Candy 0 Dry Baking Mixes 0 <br />LI Churros 0 Waffle Cones LI <br />LI Buttercream <br />Frosting/Icing* 0 Buttercream <br />Fondant/Gumpaste* El <br />El Dried Mole Paste Herb/Spice Blends LI <br />0 Fruit Empanadas 0 Fruit Tamales/Pies LI <br />LI Granola/Cereals El Seasoning Salt LI <br />El Cotton Candy El Candied Apples 1-1 <br />Popcorn/ <br />Popcorn Balls <br />Mustard El Vinegar <br />Dried Grain Mixes LI Fruit Butter"* <br />Flat Icing <br />Pizzeles LI Jams/Jellies*" <br />Nut Mixes/Nut <br />Butters <br />Fried or Baked <br />LI Donuts and <br />Waffles <br />Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />E Marshmallow <br />Bars* <br />Honey <br />Ground <br />Chocolate <br />Salted <br />Caramel/Fudge <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd