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SAN JOAQUIN Environmental Health Department <br />COIJIATV <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO BusNam <br />re: <br />❑ <br />Date: <br />CFO Physical Addres : <br />-1s I 1 C�1� <br />CFO Cfty: <br />Q <br />—� <br />,r <br />FO Zip: <br />�1533� <br />Website (If applic We): <br />Telephom <br />905-484-©`F <br />3 <br />, <br />❑ <br />Jams/Jellies" <br />Fried or Baked <br />1. Categories: <br />Donuts and <br />Waffles <br />"Class A" (Direct Sales Only) $155 <br />❑ "Class B" (Direct & Indirect <br />Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: r__T_ <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 -home illness. <br />3. "CI ss A" Self Certification Checklist: <br />131"Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />/Please check the items you will be preparing and/or selling. <br />Q� Baked Goods ❑ Dried Pasta ❑ Honey <br />❑ <br />Candy <br />❑ <br />Churros <br />❑ <br />�Buttercream <br />❑ <br />Fruit Butter' <br />Frosting/Icing' <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dry Baking Mixes <br />❑ <br />Waffle Cones <br />R�Buttercream <br />FondanVGumpaste' <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Pizzeles <br />❑ Nut Mixes/Nut <br />Butters <br />❑ <br />Popcom/ <br />Popcorn Balls <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter' <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Jams/Jellies" <br />Fried or Baked <br />❑ <br />Donuts and <br />Waffles <br />❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />❑ Candied Apples ❑ Salted Marshmallo.vs� <br />CaramellFudge ❑ Marshmallow <br />Bars* <br />❑ Dried or DehydratedDried Vegetarian - <br />Vegetables ❑ Based Soup Mixes ❑ 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,sjcehd.com <br />