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2� DD3W-1 <br /> rou�a SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �► 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s' ov.or 1EHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: er Name. Da <br /> CFO Physical Address: CFO City CFO Zip: <br /> I�S C),L4Lj 6 KkY .; hVA Mantra, ,CA G 533 �2 <br /> Websile(If applicable)_ Telephone- <br /> 1. Categories: <br /> ,Dj "Class A-(Direct Sales Only) $186 ❑ "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 /> DR�Checl list completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing andlor selling. <br /> Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcoml <br /> Popcom Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Wattle Cones ❑ Dried Grain Mixes ❑ Fruit Butter`" <br /> Buttercream Buttercream Ground <br /> Frosting/Icing* El Fonda ntlGumpaste* ❑ Fiat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit TamaleslPies ❑ gutters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge Marshmallow <br /> Bars* <br /> EHD 16-27 612912023 1 CFO REGlPERMITTING FORM <br />