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I gUIN <br /> ' Fc SAN JOQQUIN Environmental Health Department <br /> —COUNTY <br /> °gaP Greatness grows herr <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: <br /> 6a1� Owner Name: Date: <br /> Iw s taro► abharc� <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 3W � bumf G�r. Jbf �l 1152 <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> ❑ "Class N' (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 /> 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 /> El Fruit Empanadas La_rruit Tamales/Pies gutters Donuts and <br /> Waffles <br /> Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />