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* <br /> SAN� AQIIN Environmental Health Department <br /> COUNTY— <br /> ;r <br /> Greotness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO13usiness Name: Owner Nva/rp_a �J DateL <br /> CFO 94ysical Address: 11,41& <br /> CFO City: f� CFO Zip: <br /> - 5Y A/ A// 11, 1 1 /�I/-,'ro /Vo -1AgL, a? � 9539/ <br /> Website(If applicable): Telephone: <br /> gas) �i�-a33s <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $15.5 ❑ "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 /> Popcorn/ <br /> Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ vinegar <br /> ❑ Churros ❑ WefFle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> ISI Buttercream ButtercreamGround <br /> `P Frosting/Icing* Ir Fondant/Gumpaste* E] Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Donuts and <br /> LlFruit Empanadas ❑ Fruit Tamales/Pies ElButters <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning ,Salt ❑ Trail Mix/Dried Fruit [-I Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy Candied Apples ,Caramel/Fudge ❑ Bars hmallow <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- L] Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br />