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S A N A PI Q U I N Environmental Heq , LEDp 1 nt <br /> —Cour v <br /> COTTAGE FOOD OPERATIONS (CFO) ���"����>I��,ore' o: o ii° �eaai-i <br /> REGISTRATION/PERMITTING FORM bE',rAR F�iLN r <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> VX-1 (V S MW cfla-lions k1w)eu mUONA ISD fl2oZ1 <br /> CFO Physi I Address: CFO City: CFO Zip: <br /> 2ttfl I mcoy- de 65cokon °15320 <br /> Website(If applicable): Telephone: <br /> 21�qlQgl-1l�11 <br /> 1. Categories: <br /> LI -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: �DY� <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 and/or selling_ <br /> �J Baked Goods El Dried Pasta E] Honey E] Popcorn <br /> Popcom Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream ButtercreamGround <br /> Frosting/Icing* ❑ Fondant/Gumpaste* ❑ Flat Icing ElChocolate <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 ❑ 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />