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aro �A SAN JOAQUIN COUNTY <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> •+' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sicehd.com <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: 1 /�L 3 <br /> H QN E`L R,o c,_ i30/A I GAL S RE 3E GLA V1 GKR.Ey LIS; 1 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 10 21 6OVTH Ml(,LS Aver "t)I g6242 <br /> Website(If applicable): Telephone: <br /> ZVI1 )27 to I o 3 <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only)$186 MI, "Class B"(Direct&Indirect Sales)$486 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: Al <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br /> Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br /> Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br /> growth that could be a cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class X CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> N1 Baked Goods ❑ Dried Pasta Rd Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Buffer** <br /> Buttercream Buttercream Ground <br /> Frosting/Icing* ElFondant/Gum paste* E] Flat Icing ElChocolate <br /> ❑ Dried Mole Paste Nf 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 ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel./Fudge ❑ Marshmallow <br /> Bars <br /> EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />