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� t. <br /> S �( Q�� Environmental Health Department <br /> --COUNTY. , n2 <br /> �febtness g •asrs here:, �§ <br /> �Q <br /> COTTAGE FOOD OPERATIONS (CFO) elvv/&Oly 19 2021 O <br /> REGISTRATION/PERMITTING FORM PFRMMS�Tq�y <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) RtryCFS�Ty <br /> CFO Business N me: Owner Nam Date: <br /> I: <br /> ter I -11 -2oZ1 <br /> CFO Physical Address: CFO City: CFO Zip: I <br /> atc) �l r w�a►�cesrt stoub210 GA 9S2-04 <br /> VVebsite(If applicable): Telephone: <br /> Vjc/(i�CaVic,Kkjmrron . com C !�2 sy — 00ndl <br /> 1. to ories: <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 /> Baked Goods �✓ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream ButtercreamGround <br /> Frosting/Icing* 1:1 Fondant/Gum paste. Eg Flat Icing Chocolate <br /> ❑ Dried Mole Paste Ef Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/NutFried or Baked <br /> F-1Fruit Empanadas ElFruit Tamales/Pies E9 Butters R'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- <br /> ❑ Vegetables ❑ Based Soup Mixes El 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 />