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�vuip <br /> 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: s :..srg/EHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO siness Name: Own Name: I Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 2�,o 2 5-'r)-,' Z P_x� <br /> Website(If applicable): Telephone: <br /> � 7 oL <br /> 1. Cateaories: <br /> ❑ "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: �r n <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 ❑ Honey ❑ Popcom/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard <br /> ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes <br /> ❑ Fruit Butter— <br /> Buttercream Buttercream Ground <br /> Frosting/Icing* ❑ Fondant/Gumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles Jams/Jellies** <br /> Nut❑ Mixes/Nut Fried or Baked Fruit Empanadas El Tamales/Pies ❑ ❑Butters Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> El Cotton CandySalted Marshmallows/ <br /> ❑ Candied Apples ❑ ❑ Marshmallow <br /> Caramel/Fudge Bars* <br /> END 16-276/29/2023 1 CFO REG/PERMrrTING FORM <br /> �Q25��301 <br />