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01IrrJ <br /> '� , SAN J 0 A Q U I N Environmental Health Department <br /> 41k y ' COUNTY—— <br /> • .•r <br /> Greatness grows here, <br /> �D <br /> COTTAGE FOOD OPERATIONS (CFO) EnivIRAUG 15 2019 <br /> REGISTRATION/PERMITTING FORM pERMMSIVTALt,, <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) ERV/CES H <br /> CFR Business Name: Owner Name: Date: <br /> J4 a Af V Swl?+S Yema #AS j dL ,IV„ 6y.fi elf <br /> CFO Ph ical Address: I CFO City: CFO Zip: <br /> J�Z3 ► o)q PaWr) Lur►c (a GS33 <br /> Website(If applicable: Telephone: <br /> SUi1g�USWt��SSens�Ifi�nSwo�dh�tJs . �o� (l o`� �')y-03s y <br /> 1. Categories: <br /> Y, "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: ji; <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 /> 1P 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* q 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 /> T Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples Marshmallow <br /> Caramel/Fudge Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ElDried <br /> Soup Mixes ❑ 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 />