Laserfiche WebLink
SAN J O A Q U I N Environmental He�.KhfDep"nt <br /> tAN 1 1 20121 <br /> COTTAGE FOOD OPERATIONS (CFO) I-NXuacmNIEN AL nEAU11 <br /> REGISTRATION/PERMITTING FORM DEPAI rNIENT <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name- Owner Name: Date: <br /> �itlmeVs Cbk\e Cffi M arlNnNMMUJtIA II0t120yi <br /> CFO Phys!81 Address: CFO City: CFO Zip: <br /> lwt -i mc&dt W Es(600n '%SZO <br /> Website(If applicable): Telephone: <br /> 2oA �2gr��u <br /> 1.. Categories: <br /> N! "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 /> 0 Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you wdl be preparing anoVor seQing. <br /> (� Baked Goods ❑ Dried Pasta ❑ Honey El Popcorn <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ButtercreamElButtercream E] Flat Icing El Chocolate Frosting/Icing Fonda nt/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies— <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ElVegetable 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 />