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SANAHON Environmental Health Department <br /> —COUNTY-Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616(GATTO)) <br /> GFO Bsiness Name: Owner Name: Date: <br /> Larks Lir,cK �oneo- <br /> CFO Physical Address: CFO City. CFO Zip: <br /> It N, (� A-enm.(sD 015aao <br /> Website(It applicable): Telephone: <br /> 1. Categories: <br /> Q' 'Class A"(Direct sales Only)$155 ❑ 'Class 8'(Direct8 Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> AA- <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 All 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 /> Popcoml <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 Ground <br /> Frostingncing' ❑ Flat Icing Fondant/Gumpaste' ❑ ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies- <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Errlpanadas ❑ Fruit Tamales/Pies ❑ Butters Donuts and <br /> Wattles <br /> I ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mbit Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> I ❑ Cotton Candy ❑ Candied Apples ❑ Caramel(Fudge ❑ 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 952051 T 209 468.3420 1 F 209 464-0136 1 wwwsjgov.orglEHD <br />