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SAN 10A Q U I N 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: ` Owner Name: �(� y Date: <br /> V ,r I U) .� 11�N (- 1 Yr"w 1 0 I'LL ` .( 1 l s M-1 'Pad IyXy <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 2 y _E . wor.4 h 57 5.4 o C K 4 ©)1 9 OG <br /> Website(If applicable): Telephone: <br /> 1. Categories: <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: 1 <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 /> Pr Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream ❑ Flat Icing El Ground <br /> Frosting/Icing" Fondant/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals to,- 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 Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />