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SA6.1DAOUIN p <br /> 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 ame: Owner Na a gale: <br /> AL 6- A AZ r1l,Y�u�M 14 I �ZfiytJ <br /> CFO Physical Address: coo City: Q CFO Zip: <br /> �,1�t s� �� C'e��� Gv S�.Qk�cM �►s7-/ o <br /> Website]f applicable): Telephone: P Li <br /> 1. Categories: <br /> W2 "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-bome 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 ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream Buttercream Flat Icing ❑ Ground <br /> Frosting/Icing' Fondant/Gumpaste' I Chocolate <br /> I <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles 0 Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ gutters El Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Marshmallows/ <br /> Salted <br /> E] Cotton Candy El Candied Apples ❑ Caramel/Fudge El 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.sicehd.com <br /> L <br />