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�u SAN JOAQUIN COUNTY -- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �y 1868 East Hazelton Avenue, Stockton, CA 95205-6232 —r <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.s' ov or ! <br /> SEP 13 2013 <br /> COTTAGE FOOD OPERATOR REG ISTRATION/PERMITTING�R NTt"LTH <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) PERMIT/SERVICES <br /> CFO Business Name Data q <br /> 1j it <br /> CFO Physical Address. _ CFO City: CFO ZIP: <br /> Website(If applicable):t.A__�, �� <br /> tA.�c.�� , r� to J,�" K-(��``/C v , ef <br /> 1. Categories: <br /> ,-��_Class A"(Direct Sales Only) $125 ❑ "Class B" (Direct& Indirect Sales) $250 <br /> 2. Prohibited Items: Initial If you agree to abide by the following: l <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 (CFO). These are food 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 /> f7lChecklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ,,Er-_�Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Tortillas ❑ Fruit Butter"" <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Nuts/Nut Mixes ❑ Dried Fruit <br /> ❑ Granola/Cereals ❑ Nut Butters ❑ Dried Tea ❑ Trail mix <br /> Sweet Sorghum Roasted Coffee ❑ Chocolate Covered Nonperishable Food <br /> ❑ Syrup ❑ <br /> ❑ Other: <br /> These items must comply with standards described in Part 150 of Title 21 of the Code of Federal Regulations <br /> http Ywww accessdata Ida gov/scriptsicdrhiefdocs/(;fCFRICFRSearch.cfm?CFRPort=I 50 <br /> EHD 16-2712127@012 1 CFO REG/PERMITTING FORM <br />