Laserfiche WebLink
QAP1 JUAWUIIV %oUUN 1 T <br /> a x <br /> E IRONMENTAL HEALTH DEPAR ENT <br /> c 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ° Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sRcehd.com <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Busin s Name: Owner Name: I -1 Date: <br /> �or�k���i`s (ro�ot1 les-+ Candles � ►✓1�1 Lbr�t��11 3-314(- <br /> CFO Physical Address: _I CFO City: CFO Zip: <br /> -13 2 P�.rvtf IC(: (� 6t�" <br /> Website(If applicable): Telephone: <br /> 1. to ories: <br /> /11 "Class A" (Direct Sales Only) $125 ❑ "Class B" (Direct & Indirect Sales) $250 <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. <br /> Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br /> Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br /> growth that could be a cause of food-borne illness. <br /> 3. "Clad's 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 /> laked Goods ElDried Pasta ElHoney ❑ 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 El Chocolate Frosting/Icing Fondant/Gumpaste" Chocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> E] Fruit Empanadas C1 Fruit Mixes/Nut Fried or Baked Fruit Tamales/Pies ❑ El Donuts and <br /> Butters 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 /> EHD 16-276/29/2015 1 CFO REWERMITTING FORM <br />