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t. SAN�hJOAQUIN 1 p } Environmental Health Department —COUNTY— ! Greatness grows here. COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: Owner Name: Date: Z Baxe.5 AZlza 1cavft 91 I1 1 ZI CFO Physical Address: CFO City: CFO Zip: 5%, 5&na ier"Vf_ Lod, R5zy0 Website (If applicable): Telephone: NIA Zo9-z51- 9gZq 1. Categories: "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 2. Prohibited Items' Initial if you agree to abide by the following: A . k. Foods containing cream; custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that'do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-bome illness. 3. "Class A" Self Certification Checklist: Checklist completed ("Class A" CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Cotton Candy ❑ Dried or Dehydrated Vegetables ❑ Dried Pasta Dry Baking Mixes ❑ Waffle Cones ❑ Buttercream Fondant/Gumpaste* Herb/Spice Blends ❑ Fruit Tamales/Pies ❑ Seasoning Salt ❑ Candied Apples ❑ Dried Vegetarian - Based Soup Mixes ❑ Honey ❑ Popcorn/ Popcorn Balls ❑ Mustard ❑ Dried Grain Mixes % Flat Icing ❑ Pizzeles Nut Mixes/Nut l� Butters ❑ Vinegar ❑ Fruit Butter** �{ Ground 1� Chocolate Jams/Jellies** Fried or Baked ❑ Donuts and Waffles ❑ Trail Mix/ Dried Fruit )< Dried Fruit Salted Marshmallows/ Caramel/Fudge El Bars' ❑ Vegetable and Potato Chips 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD Baked Goods ❑ Candy ❑ Churros Buttercream Frosting/Icing* ❑ Dried Mole Paste ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Cotton Candy ❑ Dried or Dehydrated Vegetables ❑ Dried Pasta Dry Baking Mixes ❑ Waffle Cones ❑ Buttercream Fondant/Gumpaste* Herb/Spice Blends ❑ Fruit Tamales/Pies ❑ Seasoning Salt ❑ Candied Apples ❑ Dried Vegetarian - Based Soup Mixes ❑ Honey ❑ Popcorn/ Popcorn Balls ❑ Mustard ❑ Dried Grain Mixes % Flat Icing ❑ Pizzeles Nut Mixes/Nut l� Butters ❑ Vinegar ❑ Fruit Butter** �{ Ground 1� Chocolate Jams/Jellies** Fried or Baked ❑ Donuts and Waffles ❑ Trail Mix/ Dried Fruit )< Dried Fruit Salted Marshmallows/ Caramel/Fudge El Bars' ❑ Vegetable and Potato Chips 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD