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.Q g .� SAN JOAQUIN COUNTY <br /> r :< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' a Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/EHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business e: Owner ameljDate: <br /> �rks 2 I ) � N� �� YYy <br /> CFO Physical Addre : CFO City: CFO Zip: <br /> /e, - lel l �.se.��(A)n '�� 3 � c <br /> ebsi a(If applicable): Telephone: <br /> U jeGnttnA l <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $186 E;3/ "Class B" (Direct& Indirect Sales) $486 <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 /> ❑ 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 []r Honey Popcorn/ <br /> Popcorn Balls <br /> [� Candy [']� Dry Baking Mixes [g,*' Mustard [? Vinegar <br /> F�l Churros [✓] Waffle Cones Dried Grain Mixes a Fruit Butter" <br /> Q, Buttercream * ElButtercream [ Flat Icing © Ground <br /> Frosting/Icing Fondant/Gumpaste Chocolate <br /> Dried Mole Paste [ Herb/Spice Blends Pizzeles Jams/Jellies** <br /> Nut Mixes/NutFried or Baked <br /> Fruit Empanadas Fruit Tamales/Pies Butters QDonuts and <br /> Waffles <br /> Granola/Cereals [? Seasoning Salt [ Trail Mix/ Dried Fruit Dried Fruit <br /> Salted Marshmallows/ <br /> 0' Cotton Candy E]/ Candied Apples EZ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />