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SANJOAQUIN Environmental Health Department <br />COUNTY— <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: 1Ye il,P\ �� Owner Name: �.\`�� A�� (\D� Date: �I/�it I/f� <br />CFO Physical Address: \ Q ]\l1A CFO City: L\ `\J CFO Zip: VJy�/1 ,llJ` <br />I135u] W. JarK7oQ� U. LbW.Fp '95231 <br />Website (If applicable): Telephone: w <br />1. Categories: <br />1` 11 <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 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-bome illness. <br />3. "CI ss 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 />Q' Goods ❑ Dried Pasta ❑ Honey <br />Candy ❑ Dry Baking Mixes ❑ Mustard <br />❑ Churros ❑ Waffle Cones Dried Grain Mixes <br />Buttercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />jam' Granola/Cereals <br />VCotton Candy <br />Buttercream <br />sf/Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />Q9 Candied Apples <br />VFlat Icing <br />❑ Pizzeles <br />Nut Mixes/Nut <br />/ Butters <br />L� Trail Mix/ Dried Fruit <br />El Salted <br />Caramel/Fudge <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter** <br />El <br />Chocolate Chocolate <br />❑ <br />Jams/Jellies** <br />Fried or Baked <br />❑ Donuts and <br />Waffles <br />(Dried Fruit <br />/Marshmallows/ <br />Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 96205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />