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�l`(,l�f/���1Lt �f ZSpZ gp3 <br /> SAN JOAQUIN COUNTY z- -94 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www sjgov.ora/EHD <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 /> RM00 r PCk 9-V VAC S- - V a�A1L1��ro 1'1 '► - a <br /> CFO Physical Address: CFO City: CFO Zip: <br /> _U919 Vj �.t ko v\ g_d 4?s to r\ q S 3r J:� <br /> Website(If applicable): Telephone: <br /> (2o9) 3os- -T- 442- <br /> 1. Categories: <br /> ZL "Class A" (Direct Sales Only)$186 ❑ "Class B" (Direct& Indirect Sales)$486 <br /> 2. Prohibited Items: Initial If you agree to abide by the following: V L <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-bome illness. <br /> 3. "Class A" Self Certification Checklist: <br /> 9] Checklist 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 ❑ Popcornl <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Butlercream El Flat Icing ElGround <br /> Frosting/Icing Fondant/Gumpaste Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies'* <br /> Nut Mixes/Nut Fried or Baked <br /> Fruit Empanadas Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Sailed Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge Marshmallow <br /> Bars <br /> EHD 16-27 6l2912023 1 CFO REGIPERMITTING FORM <br />