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SAN JOAQUIN Environmenljigalth i"ment <br /> COUNTY- <br /> MAR U 3 2021 <br /> COTTAGE FOOD OPERATIONS (CFO)NVIPc:r EALTH <br /> REGISTRATION/PERMITTING FORM PI ""'" `S <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> ��a&✓ �)&n6 �6w- '3 % -2( <br /> CFO Physical Address: CM City: CFO Zip: <br /> 2� \ O 4 . V-��,.e � r5cs,.K, C 1` �IS32y <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> "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 /> 1� Popcorn/ <br /> ❑ Baked Goods Dried Pasta Honey Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> F] Churros ❑ Waffle Cones 4 Dried Grain Mixes ❑ Fruit Butter`* <br /> ❑ Buttercream ❑ Buttercream ❑ Flat Icing El Ground <br /> Frosting/Icing' Fondant/Gumpaste` Chocolate <br /> ❑ Dried Mole Paste � Herb/Spice Blends ❑ Pizzeles El " <br /> 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 jL Trail Mix/ Dried Fruit L�uried Fruit <br /> 1` Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars` <br /> {� Dried or Dehydrated Dried Vegetarian- ,�f <br /> d" Vegetables ElDried <br /> Soup Mixes t 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.sjgov.org/EHD <br /> ?WMt(A peas'511s7 v <br />