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CFO City: <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />GranolaJCereals <br />Cotton Candy <br />11] <br />EIl <br />0 <br />LII <br />El <br />0 <br />0 <br />111 <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gunnpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />El <br />LI <br />El <br />0 <br />LI <br />Ej <br />n <br />"--1 <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 />EI Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />El <br />Jams/Jellies** <br />Fried or Baked <br />[I] Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars" <br />0 <br />0 <br />El <br />Ground <br />Chocolate <br />r\ee cA/z_ pc <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT PIZ) Li 23 30 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />"c-eick(y\ ,rctd,e_ 0-C &I,Y&IkS <br />CFO Physical Address: <br />2L-110 GC't r(C,+-Ir C <br />Website (If applicable): <br />Date: <br />RV(2: <br />CFO Zip: <br />61 5 3 -1-1 -Trc‘e <br />Telephone: <br />Li)c4 ClS/-21---1 <br />Categories: <br />0 "Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <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. <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 />"Class A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />EHD 16-27 6/29/2023 <br /> CFO REG/PERMITTING FORM <br />cOobj - be-+VNG