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1 ruiN� <br /> Environment., Health Department <br /> t"' •`.i —COUNTY <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> am,gg: l Owner Name: Date: <br /> A(6Fa��Business NI <br /> A( 9/1 /17 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> �S `jrishah nl ck 0 <br /> Website(If applicable): Telephone:eQ�� �_Dqg <br /> 1. Categories: <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 ALLOWED. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> 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 /> (yam Baked Goods El Dried Pasta Honey El Popcorn <br /> { <br /> Popcorn Balls <br /> (Z Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes N� Fruit Butter*' <br /> Buttercream � Buttercream El Flat Icing El Ground <br /> Frosting/Icing' Fonda nt/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste D�, Herb/Spice Blends ❑ Pizzeles Jams/Jellies"' <br /> Nut Mixes/Nut Fried or Baked <br /> Fruit Empanadas Fruit Tamales/Pies r�' Butters ❑ Donuts and <br /> Waffles <br /> {� Granola/Cereals Seasoning Salt Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted �, Marshmallows/ <br /> F-1CottonCandy El Candied Apples Caramel/Fudge Acx Marshmallow <br /> Bars' <br /> Dried or Dehydrated Dried Vegetarian- <br /> Vegetables Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />