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SQNdOAQUIN Environmental Health Department <br />--COUNTY <br />F <br />". Greatness grows here. <br />CFO Business Name: <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: <br />Date: <br />CFO Physical Address: / CFO City: CFO Zip: <br />Website (If applicable): Telephone: <br />19 530-35_-Q'AK <br />1. C to ores: <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 <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Buttercream <br />❑ <br />Buttercream <br />Frosting/Icing* <br />Fonda nt/G um paste* <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ Fruit Empanadas ❑ Fruit Tamales/Pies <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Popcorn/ <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter" <br />❑ Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />Fried or Baked <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted Marshmallows/ <br />❑ Caramel/Fudge ❑ Marshmallow <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 209 464-0138 1 www.sjcehd.com <br />