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SAN JOAQUIN Environmental Health Department <br /> COUNTY-- <br /> . <br /> Greatness grows herr. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: �. Owner Name* <br /> �7 Date: <br /> SO—SQA T�!]K1h�, Z cknnC,1 I�P_C I� 0 –2 _ ? <br /> CFO Physical Address: CFO City: CFO Zip: <br /> �? !So)c�Y ,SA S" Anc_H 96 3Q <br /> Website(If applicable): Telephone: <br /> ( 92-5) ����� 2 6g —GGA <br /> 1. Categories: <br /> P/ "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 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 ❑ Flat Icing El Ground <br /> Frosting/Icing* Fonda nt/GuInpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends VFZK Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/NutFried or Baked <br /> ❑ Fruit Empanadas Fruit Tamales/Pies ElButters ElDonuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> SaltedMarshmallows/ <br /> r_1Cotton Candy ElCandied Apples ❑ Caramel/Fudge ElMarshmallow <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.sjgov.org/EHD <br />