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/`./°' ;-U SAN JOAQUIN COUNTY _ <br /> .�„�moo•. <br /> A, <br /> �:: • ENVIRONMENTAL HEALTH DEPARTMENT c <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sicehd.com D <br /> COTTAGE FOOD OPERATIONS (CFO) ENvly(l jm, '?015(CALIFORNIAHOMEMIAADE FOOD ACT AB 16116 GATTO)) PERMITSFgVC1Q <br /> NCFO eine �$Ar�dam I r�49 I V 1�'Ic �m l I Date �j <br /> CFQ ip- <br /> i� J <br /> hical Aa 9 l l i o l a I I D�>!J CFO CitCFO anksd - I � J <br /> Website(If applicable):l Telephone: <br /> 1. Categories: ✓JV//YAI UX J//1 <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: <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 /> ButtercreamElButtercream ❑ Flat Icing El Chocolate Frosting/Icing* Fondant/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/NutFried or Baked <br /> F-1Fruit Empanadas EIFruit Tamales/Pies ElButtersEl Donuts and <br /> WafFles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> SaltedMarshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ElCaramel/Fudge El Marshmallow <br /> Bars* <br /> EHD 16-27 6/292015 1 CFO REG/PERMITTING FORM <br />