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liqr <br />LI <br />El <br />El <br />Ej <br />El <br />El <br />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 />El <br />El <br />El <br />El <br />0 <br />El <br />0 <br />El <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gunwaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />El Honey <br />0 Mustard <br />117 Dried Grain Mixes <br />El Flat Icing <br />CI Pizzeles <br />Nut Mixes/Nut El Butters <br />CI Trail Mix/ Dried Fruit <br />c7" Salted <br />Caramel/Fudge <br />111 Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />CI <br />Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />D Dried Fruit <br />Marshmallows/ <br />El Marshmallow <br />Bars* <br />Ground <br />Chocolate <br />(\ev,)— te\-e€d72_ ese. <br /> <br />SAN JOAQUIN <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: Owner Name: <br />kai2C4Trcul R les Fro.aces Swenson Date: ) i <br /> <br />I I Q / Q-0;.)--— <br />CFO Pillysical Address: CFO City: CFO Zip. <br />3 10 LcilPwria-4,.. <br />\- <br />,A-- or , -fra_c(i <br />..v/i F Website ( - plicahle): ..v.,,c--i Telep one: <br />(.(Jen son 4 0-hoo , c onl atO5L-War 5 & 9 a- <br />Categories: <br />"Class A" (Direct Sales Only) $186 El "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-borne illness. <br />"Class A" Self Certification Checklist: <br /> RECEIVE.) <br />CI Checklist completed ("Class A" CFOs Only) <br />MAR 1 3 2023 <br />Products: ENVIRONMENTAL HEALTH <br />Please check the items you will be preparing and/or selling. PERMIT/SERVICES <br />q63.7co <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd