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Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />E I Dried Pasta <br />0 Dry Baking Mixes <br />0 Waffle Cones <br />[II Buttercream <br />Fondant/Gumpaste* <br />0 Herb/Spice Blends <br />Fruit Tamales/Pies <br />El Seasoning Salt <br />[N Candied Apples <br />111 <br />0 <br />0 <br />LI <br />D <br />1-7 <br />LI <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />vi Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />LI Fruit Butter** <br />Ground <br />Chocolate <br />3 Jams/Jellies— <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />D <br />SANJOAQUIN <br /> <br />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: <br />SVN \-10(--Y-1 ("ei 'CLS),S '+-0-1 <br />, <br />CFO Physical Address: CFO City: <br />c_\ <br />Website (If applicable): Telephone: <br />-20C 105 \-1--("R.0 Sc1 s Sk (43 <br />(24, (,c,,,,7 1. Categories: <br /> <br />t3:1 "Class A" (Direct Sales Only) $186 n "Class B" (Direct & Indirect Sales) $312 <br />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-borne illness. <br />"Class A" Self Certification Checklist: <br />V) Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Owner Name: Date: ":2:2 <br />—0(At) vt-S LL, 6-1 V..A L( ( <br />CFO Zip: <br />C't 2-(9ci <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd