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0 <br />CFO Business <br />.k <br />SAN JOAQUIN <br />COU NTY <br />eotness grows he:: <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name. <br />Date: <br />CFO Physical Address: CFO City: - CFO Zip: <br />G L 4�Gr-a\Cn� Sr)ic, Cc2urk- *N�IxY44) <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 />4 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 <br />❑ Candy <br />/utteurros <br />rcr h <br />Bercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />Dry Baking Mixes <br />❑ Waffle Cones <br />ElButtercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />[I Seasoning Salt <br />❑ Cotton Candy ❑ Candied Apples <br />❑ Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ <br />Mustard <br />❑ <br />Dried Grain Mixes <br />❑ <br />Flat Icing <br />❑ <br />Pizzeles <br />El Butters Mixes/Nut <br />Butters <br />❑ Trail Mix/ Dried Fruit <br />El <br />Popcorn <br />Popcorn Balls <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter** <br />E] <br />Chocolate Chocolate <br />❑ <br />Jams/Jellies** <br />Fried or Baked <br />❑ <br />Donuts and <br />Waffles <br />❑ <br />Dried Fruit <br />Salted Marshmallows/ <br />❑ Caramel/Fudge ❑ Marshmallow <br />Bars* <br />❑ Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />