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SAN.JQAQUIN p <br /> �5 Environmental Health Department <br /> "i) —COUNTY— <br /> `,,iw `g'" Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Omer Name: Date: <br /> Joycy Bakes Preetha Joycy Bellary Joseph 09/01/2020 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 565 N castellina Terrace Mountain house Q5,tg1 <br /> Website(If applicable): Telephone: <br /> 6696009414 <br /> 1. Categories: <br /> ,V "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: Pi <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 /> V 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 Ground <br /> ElFrosting/Icing' 1:1 Fondant/Gum paste* ❑ Flat Icing EllChocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies'" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ® Fruit Tamales/Pies Elgutters El Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ElCandied Apples ElCaramel/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 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />