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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />Swo�}0e\�ah-�s Laizta umPltc1 3I161Z,I <br />CFO Physical Address: CFO City: CFO Zip: <br />S;s2 �&tlepA Pea Ln Sk Nno) (4 q5z 12 - <br />Website (If applicable):/Telephone: <br />1ehQI 7CL _ 7LS 0 , <br />1., /Categories: <br />Lv� "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: L • C <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 />Ff�Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />El' Baked Goods <br />Candy <br />❑ Churros <br />Buttercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />El <br />Dried Pasta <br />El <br />Honey <br />El <br />Popcorn Balls <br />Popcorn <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />ButtercreamFlat <br />Icing <br />El <br />Fondant/Gumpaste* <br />Chocolate <br />Chocolate <br />❑ <br />Herb/Spice Blends <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />(� <br />Fruit Tamales/Pies <br />Nut Mixes/Nut <br />�,/ <br />NJ <br />Fried or Baked <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Seasoning Salt <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />❑ <br />Candied Apples <br />❑ <br />Salted <br />❑ <br />Marshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars* <br />❑ Dried or DehydratedEDDried 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.sjgov.org/EHD <br />