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SANJQAQUIN Environmental tAe l h <br /> 9`9 a tment <br /> .vV —C0UNTY— <br /> �� Greatness grows hem <br /> APR 2 3 20'9 <br /> COTTAGE FOOD OPERATIONS (CFO)N"'I ()NNIEN IAL 11EAum <br /> REGISTRATION/PERMITTING FORM 1)1'rk11TnIENT <br /> (CALIFORNIA HOMEMADE FOOD ACT AS 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> of f' er naP enc 'f <br /> CFO Physical Address: CFOC y CFO Zip: <br /> 2 <br /> Website(If applicable): Telephone: <br /> __49— Z69. 60eY, 3S27 <br /> 1. Categories: <br /> l�'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: /YLJ <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 reffigeration 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 /> P Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/orselling. <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 El Buttercream ❑ 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 /> F-1Fruit Empanadas LlFruit Tamales/Pies ElButters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- [_1Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <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 />