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a°4�t SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a'a <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s6cehd.com <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> My hkmk's Coo kleS sltLI, f� Quashntc�k IA-Iq--1r7 <br /> CFO Physical Aftess: CFO City: CFO Zip: <br /> 151 rgbke_1k&Mne"Rtvel^ bl,^, fid', 0 F} 61sz'�6 <br /> Website(If applicable): Telephone: (-209) L N ^G�3 <br /> 1. Categories: 0� 1 <br /> ❑ "Class A" (Direct Sales Only) $146 "Class B"(Direct& Indirect Sales) $292 <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 AL WED. <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 ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> ❑ Buttercream ❑ Buttercream Flat Icing ❑ Ground <br /> Frosting/Icing* Fondant/Gumpaste* � Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ El Donuts and <br /> Butters Waffles <br /> i <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> ❑ Cotton CandySalted Marshmallows/ <br /> ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> EHD 16-277/27/17 1 CFO REGIPERMITTING FORM <br />