Laserfiche WebLink
kSANJQAQUIN a <br /> Environmental Health De artment <br /> —COUNTY— <br /> .: <br /> cg4r Greatness grows here. <br /> COTTAGE FOOD.OPERATIONS (CFO) <br /> :REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: . <br /> (7014411 NIU1)n Bakery 61u znIl'iFUrio, U AbliaaraAt Vo YO 011f112026 <br /> CFO Physical Address: , - CFO City: CFO Zip: - <br /> 1151 ��rktatur Dr Ludi ��2�12 <br /> Website(If applicable): Telephone: <br /> qyq-t21y -0� 5d� <br /> 1. Categories: <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: W-k- <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 /> R Baked Goods El Dried Pasta El Honey El Popcorn <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream Buttercream d Flat IcingGround <br /> Frosting/Icing* Fondant/Gumpaste* E] 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 /> I/ Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples u 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 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br /> QP%to, <br />