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SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> ` ,. vreoto a;s Cr` :a here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Nam Dale: <br /> SwettQi _6�� L� 10I14IZo <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Webslte(If applicable): Telephone: <br /> to50 - blob <br /> 1. Categories: <br /> 9 "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 /> Eef Baked Goods ❑ Dried Pasta ❑ Honey ElPopcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard <br /> ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes <br /> ❑ Fruit Butter** <br /> ❑ Buttercream ButtercreamGround <br /> Frosting/Icing* El FondantIGumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles <br /> ❑ Jams/Jellies*' <br /> E] Fruit Em anadas Nut Mixes/Nut Fried or Baked <br /> p ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit <br /> ❑ Dried Fruit <br /> ❑ Cotton Candy El Candied Apples El Salted Marshmallows/ <br /> CaramellFudge ❑ Marshmallow <br /> Bars* <br /> ❑ Dried or Dehydrated E] Dried Vegetarian- <br /> Vegetables Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD <br />