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N =;Foc-" <br /> SAN JOAQUIN Environmental Health Department <br /> C0UNT .-- <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616(GATTO)) <br /> CFO(,us,ness Naame- Owner Name. Date: <br /> �jG�ptTS .V DoLLGf2 �ICl1�lP �CLC� /•3� - ate 3 <br /> CFO Physical Address: CFO City. CFO Tp: <br /> /9 s I£3 V, '2, PC,'') 5 31,4, <br /> Website(lt applicable): Telephone: <br /> X09 • y 3'l- 7555 <br /> I. Categories: <br /> [ K 'Class A"(Direct Sales Only)$186 ❑ 'Class B"(Direct&Indirect Sales)$312 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: 51 <br /> Foods containing cream,custard,or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br /> that are defined as'non-potentially hazardous"are approved for preparation by a Cottage Food Operation.These <br /> foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br /> food-bome illness. <br /> 3. "Class A"Self Certification Checklist: <br /> R 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 ❑ Popcorn/ <br /> Popcorn Bails <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter' <br /> Fil Buttercream ® Buttercream ❑ Flat Icing ❑ Ground <br /> Frostingllcing` Fondant/GumpasteChocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ PFaeles ❑ 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 /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ CarameVFudge ❑ Bars* <br /> f8ti8 E.H'azePon Avenue f 9bzkv_n,.Cwrifenlfa 952o5( T 209 468-3426 1 F 2--.39 4�!4-0I Z ) ww*=qe 71-- <br />