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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 sigov orq/EHD <br />ti 51-1 Ipt5 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />c,\A \ ( OVA 3 0 C J AA e 3 1z 6/2,Gi <br />CFO Zip: <br />Z. <br />Website (If applicable): <br />(C'iv\ / De- (-t6ttAl <br />Telephone: <br />trt k - 175 -S"(6S <br /> <br />Categories: <br />t4IN "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 />D Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 Popcorn/ lk Baked Goods D Dried Pasta Ill Honey Popcorn Balls <br />LI Candy I] Dry Baking Mixes D Mustard D Vinegar <br />0 Churros El Waffle Cones 0 Dried Grain Mixes El Fruit Butter — <br />El Buttercream El Buttercream D Flat Icing 0 Ground <br />Frosting/Icing* Fondant/Gumpaste* Chocolate <br />El Dried Mole Paste D Herb/Spice Blends D Pizzeles 0 Jams/Jellies** <br />Fried or Baked Nut Mixes/Nut D El Fruit Empanadas D Fruit Tamales/Pies 0 Donuts and Butters Waffles <br />111 Granola/Cereals 0 Seasoning Salt 111 Trail Mix/ Dried Fruit III Dried Fruit <br />Marshmallows/ Salted D Cotton Candy ID Candied Apples 0 El Marshmallow Caramel/Fudge Bars* <br />EHD 16-276/29/2023 1 CFO REG/PERMITTING FORM <br />CFO Physical Address: CFO City: <br />oc C \A"k 16k,t4 (tat