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SANg}JOAQUIN Environmental Health Department <br /> COUNTY—- <br /> ±!s? Greatness grows her, <br /> COTTAGE FOOD OPERATIONS (CFO) Go ec <br /> REGISTRATION/PERMITTING FORM `� � <br /> (CALIFORNIA HOMEMADE FOOD ACT AS 1616 (GATTO)) SEP p y 2018 <br /> CFO Business Name: Omer Name: EDI <br /> wn0NMENrAL <br /> Pj-)nl',k e— Alco « (cll lliS R1fr fACES�ry <br /> CFO Physical Address: CFO City: CFO Zip: <br /> I8t7n 0_0Ur-L Lod, CR 95ayo <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> IK "Class A" (Direct Sales Only)$165 ❑ "Class B°(Direct& Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: au) <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 /> 9 Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Yf 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 ❑ Ground <br /> EI Flat Icing <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 ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> El Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Bars Marshmallow <br /> ❑ Dried or Dehydrated E] 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 209 464-0138 1 www.sjcehd.com <br />