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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov orq/EHD <br />N <br /> <br />PRocitZi 33 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name, Date: <br />free7ameboAnNeerin. 61-r4b1 1\iet,1 .012Q., 11 2 <br />CEO Physical Physical Address: CFO City: / CFO Zip: <br />Li? (int-ales Mike_ man k-M CA qS73(1? <br />Website (If applicable): Telephone: <br />c.20 el • 413 d 060 zyb <br />CFO Business Name: <br />Categories: <br />0 "Class A" (Direct Sales Only) $186 <br />Prohibited Items: <br />px vnert- epeoPt- <br />E1' "Class B"(Direct & Indirect Sales) $486 <br />-arr. <br />Initial if you agree to abide by the following: <br />Foods containing 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 />El Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El <br />CI <br />El <br />El <br />0 <br />0 <br />0 <br />E <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 />E <br />C1 <br />E <br />El <br />El <br />El <br />E <br />El <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />El <br />El <br />El <br />0 <br />El <br />1--7 <br />" <br />CI <br />r-1 <br />" <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 />El Popcom/ <br />Popcorn Balls <br />El Vinegar <br />E Fruit Butter** <br />El Ground <br />Chocolate <br />1:1 Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />El Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM