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SANDJOAQUIN <br />—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO BusinesName: Owner Name: Date: <br />The Peker-ed- Peppe Lean Delashiw-alvei ti/ao/azia-1 <br />CFO Zip: <br />95-5 <br />Website (If applicable): Telephone: 9_09- L/70 -09.7 41 <br />1. Categories: <br />f_claslA;10iif0-ct.SaleS Orily)')S155,tf... ; ....Cad (Direct Sales) t310 <br />' • G , I • . :1 L.! r :3, k . , <br />rehibited Itemse Initial if Yo'u agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT 4LOVYED. Only <br />fqods_thattarehlefined 'dS *ildril5oteritially -tiazardous7.1tare 6pproved•fberprop'aStion,l4 .Ocittage' geoid Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that pould be a ;.. <br />cause of food-borne illness <br />Class A" Self Certification Checklist: <br />0 Checklist completed (Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Popcom/ Baked Goods 0 Dried Pasta 0 Honey Popcorn Balls <br />El Candy 0 Dry Baking Mixes 0 Mustard 0 Vinegar <br />Churros 0 Waffle Cones 0 Dried Grain Mixes 0 Fruit Butter" <br />Buttercream 0 Buttercream Flat Icing 0 Ground <br />Frosting/Icing* Fondant/Gumpaste* Chocolate <br />Dried Mole Paste 0 Herb/Spice Blends 0 Pizzeles 0 Jams/Jellies** <br />Fried or Baked <br />ID Fruit Empanadas 0 Fruit Tamales/Pies 0 Nut Mixes/Nut Donuts and Butters Waffles <br />Granola/Cereals 0 Seasoning Salt 0 Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />Cotton Candy 0 Candied Apples Salted Marshmallow Caramel/Fudge Bars* <br />D Dried or Dehydrated ri Dried Vegetarian- <br />' Vegetables Based Soup Mixes Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />0205-1-Riakiko <br />CFO Physical Address: CFO City: <br />1/3 9-8-j4, ararri- Lou- Load -react/ <br />a e_ \ cAs\-\c..v..) ceD0 ceencoks-k- . <br />s I • •/ • i <br />•