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L. <br />SAN JOAQUIN Environmental Health Department <br />---COUrI_= <br />„._. COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Own r Nama: Date: 1 <br />CFO Business <br />CFO City: V" CFO Zip: <br />CFO Ph ical Atldress: a1 <br />C�OGk-tD`� l'P< r'1/f, <br />Websfte(if appl"ble): Telephone: oq) I;m_ /1"nA <br />1. Ciatenorles: <br />El "Class A" (Direct Sales Only) $155 "Class 8" (Direct 8 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-bome illness. <br />3. "Class A" Self Certification Checklist: <br />EP Checklist completed ("Class A' CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />[Q� <br />/❑ <br />Baked Goods <br />❑ <br />Candy <br />❑ <br />Churros <br />Buttercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />�q Buttercream <br />Y+ Fondant/Gumpaste' <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />T Candied Apples <br />Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ <br />Honey <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />❑ <br />Flat Icing <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />Fried or Baked <br />El <br />Mixes/Nut <br />❑ <br />Donuts and <br />Butters <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Marshmallows/ <br />❑ <br />Salted <br />❑ <br />Marshmallow <br />CaramellFudge <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 sigov.org/EHD <br />