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SAN JOAQUIN COUNTY ] <br /> ENVIRONMENTAL HEALTH DEPARTMENT J� <br /> '`: 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ' <br /> *" Tele <br /> ,• ,• y phone: (209) 468-3420 Fax: (2139)464-0138 Web:www.s cehd.com. <br /> E <br /> MAR r 2017 <br /> COTTAGE FOOD OPERATIONS (CFO) 0NP1R�M6NTA <br /> REGISTRATION/PERMITTING FORM ERM1Tjse2vlygALN <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> CFO Physical Address: CFO City:It <br /> CFO Zip: <br /> X37 R C�'r�,j�- s ,Lo,,► /a. .�'�/�-Website(If(If applicable): Telephone: <br /> �o q—S66 <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $133 ❑ "Class B" (Direct& Indirect Sales) $265 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: "1r <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 E] Dried Pasta ❑ Haney E] Popcorn/Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ ButtercreamElButtercrearn A ❑ Flat Icing Y ❑ Ground <br /> Frosting <br /> //cing* Fondant/Gum aste Chocolate <br /> ❑ Dried Male Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> ' Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas [:1 Fruit Tamales/Pies ElNut ❑ `Donuts and <br /> Waffles <br /> ❑ Granola/Cereals .❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ El Marshmallow <br /> Caramel/Fudge Bars* <br /> EHE 16-27 8112116 1 CFO REGIPERMITTING FORM <br />