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�(L o g32 <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 /> CFO Business Name: Owner Name: Date: <br /> Anna's Irresistibles Annamarie Gwerder 6/24121 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 18481 Paradise Road Tracy 95304 <br /> Website(If applicable): Telephone <br /> -Zg s <br /> 1. Categories: <br /> ❑ "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: AG <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 /> F-1Baked Goods ElDried Pasta ElHoney b7 Popcorn/ <br /> Popcorn Balls <br /> [�' Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream ❑ Flat Icing ❑ Ground <br /> Frosting/Icing" Fondant/Gumpaste` Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies'" <br /> Nut Mixes/NutFried or Baked <br /> F1Fruit Empanadas ElFruit 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- <br /> ❑ Vegetables E:] Based Soup Mixes E] Vegetable and Potato Chips <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 /> S <br />