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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> .. GrrntnPtc ilrnwt <br /> COTTAGE FOOD OPERATIONS (CFO) MAR 22 2019 <br /> REGISTRATION/PERMITTING FORM ENVIRONMENT <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) PERMITySE A/ SETH <br /> CFO Business Name: <br /> Ow�e Name: ` / Date: <br /> Fhc wba�et-� <br /> 2- -�_ <br /> CFO Physical Address: CFO Ci CFO Zip: <br /> �?9�5- Po bI m0(s3,6j� <br /> Website(If applicable): Telephone: <br /> 1. Categories* <br /> X71ass A" (Direct Sales Only) $155 "Class B" (Direct& Indirect Sales) $310 <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 /> 'RTChecklist 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 Butters ElDonuts 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 /> XBars* <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />