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SAN JOAQUIN <br /> <br />Environmental Health Department <br />C CAJ N <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name <br /> Owner Name: Date: <br />Corn Poppy Produce Jessica Bryant 4/3/2020 <br />CFO Physical Address: <br /> CFO City: CFO Zip: <br />8238 Segarini Ct. Stockton 95207 <br />Website (If applicable): Telephone: <br />209-507-1024 <br />Categories: <br />0 "Class A" (Direct Sales Only) $155 171 "Class B" (Direct & Indirect Sales) $310 <br />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 />"Class A" Self Certification Checklist: <br />LII Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />E <br />E <br />LII <br />I=1 <br />E <br />0 <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />Dried or Dehydrated <br />Vegetables <br />El <br />E <br />E <br />0 <br />LI <br />E <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />Dried Vegetarian- <br />Based Soup Mixes <br />E <br />E <br />0 <br />E <br />E <br />El <br />CI <br />LI <br />Popcorn/ Honey Popcorn Balls <br />Mustard E Vinegar <br />Dried Grain Mixes 0 Fruit Butter** <br />Ground Flat Icing LI Chocolate <br />Pizzeles El Jams/Jellies** <br />Fried or Baked Nut Mixes/Nut Ei Donuts and Butters Waffles <br />Trail Mix/ Dried Fruit IA Dried Fruit <br />Marshmallows/ Salted <br />Caramel/Fudge El Marshmallow <br />Bars* <br />Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464 -0138 I www.sjcehd.com