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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> + 1868 last Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telophone: (209)468-3420 Fax:(209)464-0136 Web: www sjg(Iv ar IEt[fi) <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> Ownor Namn Bale <br /> Cl­0i31I11117Uy5 Noun++ r QQ� D �2,024 <br /> AONMA1 �lS P�1. _ _V I rl.- Q 4 rj CFO Zip <br /> CFO Physical Addross CFO City D <br /> LWS_, 0 D�?S t,ll p I�G TO <br /> wedulro(11 applicable) — Tolo- Ph ° D <br /> 1I,1L � <br /> I. Categories:'Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct 8 Indirect Sales) S486 <br /> Y <br /> 2. Prohibited Items: 9 <br /> you Initial if 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 /> Popcorn! <br /> ❑ Baked Goods ❑ Dried Pasta ❑ Honey Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter— <br /> El Buttercream ❑ Buttercream ❑ Flat icing ElGround <br /> Froshnglicing Fonda nt/Gum paste' Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mlxes[Nut Fried or Baked <br /> ❑ Frurf Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Marshmallows! <br /> Cotton Candy ❑ Candied Apples ❑ Salted aramellFudge ❑ Marshmallow <br /> Bars" <br /> r 14) 1n-11 IV;MI207] i <br /> CFO REG/PERMITTING FORM <br />