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0 5 L1�q ZW <br /> Y\e c�2- ►� <br /> SAN .JOAQUIN COUNTY <br /> < ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sj.qov.org/EHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOT) ACT AR 1616 (GATTO)) <br /> CFO Business Name Owner Name f a+n G <br /> SYIRMTANIOo_ I�.IVIA►`tl�-- <br /> CFO Physical Address CFO City ',r r /r <br /> Website(If applicable) Telephone <br /> 2 61 -- <br /> 1. Categories: <br /> v❑' "Class A- (Direct Sales Only) $186 ❑ "Class B"(Direct&Indirect Sales)$486 <br /> 2. Prohibited Items: Initial if you agree to aul&; ty the following: S r_ <br /> Foods containing cream, custard, or meat fillings are potentially liczavlovs, 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 /> arowth that could be a cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> D-16hecklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn. <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream El Flat Icing ❑ Ground <br /> Frosting/Icing' Fonda nt/Gumpaste' Chocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut ried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters Donuts and <br /> Waffles <br /> i <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows! <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars" <br /> EHD 1627 6/29/2023 1 CFO REG/PERMITTING FORM <br /> 5 <br />