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Q . Su\ q9 <br /> SHAAQNp <br /> Environmental Health Department <br /> y <br /> —COUNTY---- <br /> Greatness <br /> OUNTY----_Greatness grows Caere. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> _< 1Wee-�/ayers /'-1 i-�et 41)dt(/ kaw <br /> CFO Physical Address: I CFO City: CFO Zip: <br /> Iyao 6aadit'lell s4- Za-llrz,P t 3317 <br /> Website(If appglicable): Telephone: <br /> 1. Categories: <br /> L3' "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: AA ,A.. <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 /> Baked Goods ElDried Pasta 0/Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream ❑ Buttercream 011,Flat Icing P Ground <br /> Frosting/Icing Fondant/Gumpaste` Chocolate <br /> ❑ Dried Mole Paste [d Herb/Spice Blends ❑ Pizzeles Jams/Jellies"` <br /> Nut Mixes/Nut -/Fried or Baked <br /> F1Fruit Empanadas ElFruit Tamales/Pies Butters Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt Q� Trail Mix/ Dried Fruit [Dried Fruit <br /> Salted Marshmallows/ <br /> Cotton Candy ❑ Candied Apples Caramel/Fudge 9 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.sjgov.org/EHD <br />