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P- "c S A Nd 0 A Q U IN Environmental Health Department <br /> COUNTY <br /> �a�F��• Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: , Date: <br /> 1 <br /> a S CUo(Y+Oo <br /> CFO Physical Address: FO City: CFO Zip: <br /> g 0 3 t6 g R&Oocl Dna �-O A i 6152-40 <br /> Website(If applicable): Telephone:_��) _q� _I�o <br /> cl <br /> 1. Categories: I <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 �EJ Vinegar <br /> Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> / Buttercream Buttercream Ground <br /> ❑ Frosting/Icing* ElFondant/Gumpaste* Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends XX Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas Fruit Tamales/Pies Butters 9 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 E] Dried <br /> 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 />