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S A N J O A Q U I N Environmental Health Department <br /> —COUNTY— <br /> .(Z) <br /> Greatness grows here. <br /> qp tV <br /> COTTAGE FOOD OPERATIONS (CFO) Fiy��R R OZ � <br /> REGISTRATION/PERMITTING FORM pFFN ?019 <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) Xf/4 <br /> 4 <br /> FTq< <br /> Rgi FS�Tti <br /> CFO Business Name: Owner Name: Vj 1 T`r1,,WWA Date: Ga <br /> �rbul,'Ua��I--ECV(��1 �Vlf' - ��a: �YtL►��S p�YA�lf, t, 1�nTF__,tYVY! "2 <br /> CFO Physical Address: CFO City: J CFO Zip: <br /> 'Q lqs2_� <br /> Website(If applicable): Telephone: <br /> �C_OLrbur-ka @56c4lobed • kit* <br /> 1. Categories: <br /> ❑ "Class 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 /> ❑ 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/G u m paste* 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 ❑ 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- <br /> ❑ Vegetables 1:1 Dried <br /> Soup Mixes F-1 Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />