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„ye_wr,°az SAN.JOAQUIN Environmental Health Department <br /> —COUNTY <br /> �°`�r Greatness grows here. <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 /> rAmiLY rlEs PAIZT-/ li�CSic,.AJS t1C7A1100F SAAJCHEZ <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Z�4Z Ni03ZAP_A A\-)E STOCKT0tQ gS2Ct <br /> Website(If applicable): Telephone: <br /> 1. Categories: M o�\\0�\K 4e (�ch e - X15 G -) - C/�Syn <br /> 4 "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: cz�l <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 ® Buttercream El Flat Icing ® Ground <br /> Frosting/Icing' Fondant/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ® Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ® Butters ® Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ® Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy [J Candied Apples © Caramel/Fudge ® Marshmallow <br /> Bars* <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ® Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />