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J • - r ��1{E�. <br /> SAN JOAQUIN COUNTY <br /> u ENVIRONMENTAL HEALTH DEPARTMENT <br /> •'. `t 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REG ISTRATIONIPERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: - _ - - — - - - Date: <br /> Ckh kk9 W k 19L44 <br /> CFO Physical Address: CFO City: CFOYip: <br /> ?(A Ay% *12 LIP 'm anje ck , CA CL S 3.3� <br /> Website(if applicable): Telephone: <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $125 ❑ "Class B" (Direct&Indirect Sales) $250 <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 /> 3. "Class A" Self Certification Checklist: <br /> PT Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you wi.11 be preparing and/or selling. <br /> ®Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Tortillas ❑ Fruit Butter** <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Nuts/Nut Mixes ❑ Dried Fruit <br /> ❑ Granola/Cereals ❑ Nut Butters ❑ Dried Tea ❑ Trail mix <br /> Sweet Sorghum <br /> E]. Syrup ElRoasted Coffee ❑ Chocolate Covered Nonperishable Food <br /> ❑ Other: <br /> **These items must comply with standards described in Part 150 of Title 21 of the Code of Federal Regulations <br /> htt ://www.accessdata.fda. ov/scri ts/cdrhlcfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> EHD 16-27 1/6/2014 1 CFO REGIPERMITTING FORM <br />