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SAN JOAQUIN —COUNTY Environmental Health Department COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name ^ o_ ke c Owner NameX: IC� a .7 uIeMa nt),r'o Date: CFO PhYI S Address762 E E. �rorlf S+. CFO City: L, n � er CFO 4:5 1 � 6 Website (If applicable): Telephone: (^ n q) q M — ^ /a 1 0 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: J� 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 -borne 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. XBaked Goods ❑ Dried Pasta ❑ Honey ❑ Candy ❑ Churros ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Buttercream ❑ Frosting/Icing* ❑ Dried Mole Paste ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Dry Baking Mixes ❑ Waffle Cones Buttercream Fondant/Gumpaste* ❑ Herb/Spice Blends ❑ Fruit Tamales/Pies ❑ Seasoning Salt ❑ Cotton Candy ❑ Candied Apples ❑ Dried or Dehydrated ❑ Dried Vegetarian - Vegetables Based Soup Mixes ❑ Mustard ❑ Dried Grain Mixes ❑ Flat Icing ❑ Popcorn/ Popcorn Balls ❑ Vinegar ❑ Fruit Butter** ❑ Ground Chocolate ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut Fried or Baked ElButters Donuts and Waffles ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallows/ El El Marshmallow 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