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SANAOAQUIN .Environmental Health Department <br /> —COUNTY— <br /> 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 /> Sofia Gta wyvWr(u A-MA <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 941bCAIP,iRo tii11S lAn1� S10G�tOn g520co <br /> Website(If applicable): Telephoner J 900T <br /> 1. Categories: ,jL�tf'�1X <br /> NJ "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 NO LLOWED. 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 /> uv 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 /> E] Buttercream * ❑ Buttercream * ❑ Flat Icing ❑ Ground <br /> Frosting/Icing Fondant/Gumpaste Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> El Fruit Empanadas ❑ Fruit Tamales/Pies E, ❑ Donuts and <br /> Butters Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> E3Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ❑ Based Soup Mixes El <br /> and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd Com <br />