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vv I i r+vr, rvvv vrcrvw r tvrrv0 �%,rv) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: f- Owner Name: Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> ly-tl D6ii11aGol PI 117f,ut(A- 4/S -36 <br /> Website(If applicable): Telephone: <br /> Q0C1- sly/- 'ILK <br /> 1. <br /> 1.. Categories: <br /> is/ "Class A" (Direct Sales Only) $155 ❑ "Class B"(Direct R Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: l' <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 /> ❑ Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> d Baked Goods ❑ Dried Pasta El Honey El Popcorn <br /> ,�, <br /> / Popcorn Balis <br /> 13 Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> 5 Buttercream ❑ Buttercream I( Flat Icing ❑ Ground <br /> Frosting/Icing* Fondant/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 ❑ gutters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted �,/ Marshmallows/ <br /> ❑ Cotton Candy El Candied Apples ❑ CarameVFudge 51 Marshmallow <br /> Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ElDried <br /> Soup Mixes F-1 Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 95205 T 209 468-3420 1 F 209 464-0138 1 wvvw.sjgov.org/EHD <br />