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SAN 10AQU I N Environmental Health Department <br /> `. COUNTY <br /> `-,;,;,,�•:• Greatness grows herr <br /> � D <br /> COTTAGE FOOD OPERATIONS (CFO) APR 2 4 2019 <br /> ENVIRONMENTAL H <br /> REGISTRATION/PERMITTING FORM PERMIT/SERVICES <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> Cl � cc�S_ '� e� ,a n firma � �c�n k e�^�� ti I � I I q <br /> CFO Physical ddress: CFO City: CFO Zip: <br /> L Z� L <br /> Website(If applicable): Telephone: _ <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 /> tZ 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 ButtercreamGround <br /> 7 Frosting/Icing* Fondant/Gumpaste* ❑ Flat Icing ❑ 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 /> Marshmallows/ <br /> Salted <br /> ❑ Cotton Candy ❑ Candied Apples K Marshmallow <br /> Caramel/Fudge <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 209464-0138 1 www.sjcehd.com <br />