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CFO Business Nam 46 <br />CFO Physical Address: CFO City: CFO Zip: <br />ii amtia cf. Mankca 61S-33(0 <br />a <br />vtheilOwner Name: 1\\4otkird a Date: 11 111 23 <br />Fried or Baked I= Donuts and <br />Waffles <br />Trail Mix/ Dried Fruit 0 Dried Fruit <br />Salted <br />Caramel/Fudge <br />Marshmallows/ Li Marshmallow <br />Bars* <br />Vegetable and Potato Chips <br />Nut Mixes/Nut <br />Butters <br />Honey <br />Mustard <br />Dried Grain <br />Flat Icing <br />Pizzeles <br />Popcorn/ <br />Popcorn Balls <br />CI Vinegar <br />Mixes 0 Fruit Butter** <br />El <br />1= Jams/Jellies'* <br />Ground <br />Chocolate <br />?Rost-18W°' <br />SAN JOAQUIN <br />C N T Y• <br />et.1 t <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Website (If applicable): Telephone: t o 014, Loss_ <br />ate ories: <br />ii1 "Class A" (Direct Sales Only) $155 0 "Class B" (Direct & Indirect Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: 10> <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />WChecklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods El Dried Pasta 111 <br />El Candy Dry Baking Mixes El <br />Churros 0 Waffle Cones El <br />Buttercream <br />Frosting/Icing* LI Buttercream <br />Fondant/Gumpaste* El <br />0 Dried Mole Paste CI Herb/Spice Blends <br />1=1 Fruit Empanadas El Fruit Tamales/Pies El <br />0 Granola/Cereals 111 Seasoning Salt 0 <br />El Cotton Candy 0 Candied Apples El <br />Ei Dried or Dehydrated <br />Vegetables <br />ni Dried Vegetarian- <br />Based Soup Mixes 1=1 <br />1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 468-3420i F 209 464-0138 I www.sjgov.org/EHD