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e 6q_ <br />?O5 1535D <br />SAN JOAQUIN <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br /> 1.11, <br />Owner Name: <br />7)ebo\ e <br />2 <br />C:11)1Physica DAddeLre7.1. L CEO City 7001.3 (t (.6 <br />Webs ite (If applicable) Telephone. <br />Categories: <br />yl "Class A" (Direct Sales Only) $186 0 "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 />0 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods <br />0 Candy <br />0 Churros <br />11. <br />Buttercream <br />Frosting/Icing* <br />0 Dried Mole Paste <br />0 Fruit Empanadas <br />0 Granola/Cereals <br />0 Cotton Candy <br />0 Dried Pasta <br />0 Dry Baking Mixes <br />0 Waffle Cones <br />/ <br />Buttercream <br />Fondant/Gumpaste* <br />0 Herb/Spice Blends <br />0 Fruit Tamales/Pies <br />0 Seasoning Salt <br />0 Candied Apples <br />0 <br />0 <br />0 <br />0 <br />0 <br />C7 <br />0 <br />I1 <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 />0 Jams/Jellies** <br />Popcorn/ <br />Popcorn Balls <br />[-.] <br />0 Vinegar <br />0 Fruit Butter** <br />Ground 0 Chocolate <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />1868 E Hazelton Avenue I Stockton, California 95205 ! 1 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />Date <br />Li