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SAN JOAQUIN Environmental Health Department COUNTY— .:al:ness grows here. COTTAGE (FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CAUFORNIIA HOMEMADE FOOD ACT AB 1616 (GATTO)) t , it,/pi. Website (If applicable): Telephone: 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: Cil 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 K CFOs Only) 4. Products: Please check the items you will be preparing andlor selling. Baked Goods ❑ Candy ❑ Churros ❑ Buttercream Frosting/Icing* ❑ Dried Mole Paste ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Cotton Candy ❑ Dried Pasta ❑ Honey ❑ Popcorn/ Popcorn Balls ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** ❑ Buttercream ❑Flat Icing ❑ Ground Fondant/Gumpaste* Chocolate ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut ed ❑ Fruit Tamales/Pies ❑ El DonFrieuts aBd Butters Waffles ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow Bars* ❑ Dried or Dehydrated ❑Dried Vegetarian- ElVegetable and Potato Chips Vegetables Based Soup Mixes