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. I <br /> SAN:JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> . Grrotness grmrs herr. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616(GATTO)) <br /> CFO Bminess Name: 7PrMET's 6H1� KEIZOmer Name: Date: <br /> y �Ar�itT OSF_I—V�vsy <br /> CFO Ptryscal Addri=: CFO City: CFO Zip: <br /> 32 6 Sv7 i R(ck Uhn(E S�—1ockTorf <br /> Website(If a,Ocaue): - Tel ne: <br /> In n' nne ba gne�OSuuvsv E10— �5� <br /> Jc ma.(,ca M <br /> 1. Categories: <br /> ❑ 'Class A'(Direct Sales Only)$155 IN 'Class B'(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 am 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 /> ❑ 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 ❑ Popcoml <br /> Popcom Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Chunos ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter— <br /> El Buttercream ❑ Buttercream ❑ Flat Icing ❑ Ground <br /> FrostingAcing• Fondant/Gumpasta Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Nut Mixes/Nut Fried or Baked <br /> Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Salted Marshmallows/ <br /> Caramel/Fudge ❑ Marshmallow <br /> Bars' <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ❑ Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazolton Avenue 1 Stockton,Collfomla 95205 1 T 209 468.34201 F 209 464-0138 1 www.sjgov.org/EHD <br /> �r o/—j v,u q <br /> Scanned with CamScanner <br /> J <br />