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SAN JOAQUINa <br /> Environmental Health Department <br /> --COUNTY-_---- <br /> .:-..r:_ <br /> ,- Greatness grows here. <br /> � <br /> COTTAGE FOOD OPERATIONS (CFO) 8 2020 <br /> REGISTRATION/PERMITTING FORM EN�RSEP 0ONMENTA� <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) PERMtr/SEQC,LTH <br /> CFO Business Name- Owner me: Date: <br /> n cn� l a -L <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 7_095W, lllo I a <br /> Website(If applicable): Telephone: <br /> 1. C to ories: <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: Yv1 j CIn1t-e" GID)"cem <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 /> Popcorn/ <br /> Popcorn Balls <br /> [Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Q/ 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 /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies Butters Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted ,^marshmallows/ <br /> ❑ Cotton Candy Candied Apples ElCaramel/Fudge a' 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 />