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S A N J Q A Q U I N Environmental Health Department <br /> COUNTY <br /> Greatness gro:�,s here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB161 6 (GATTO)) <br /> CFO Business Name Owner � <br /> eJUVVC- YJ fc)IV 8MV1Aft <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Pv4% PING MtA�Ow air9TW--KTON 95211 <br /> Website(If applicable): Telephone' <br /> — (Loq? 9-38ey38�- <br /> 1. Categories: — / <br /> El "Class A" (Direct Sales Only) $155 l� "Class B" (Direct&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 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-home 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 El Dried Pasta El Honey El Popcorn <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Motes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ ButtercreamEl ❑ Flat Icing Buttercream El Chocolate Frosting/Icing` Fondant/Gumpaste' Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/jellies— <br /> Fried <br /> ❑ B <br /> Fruit Empanadas ❑ Fruit Tamales/Pies <br /> ❑ Nut Mixes/Nut ❑ Donuts and <br /> Butters Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Moa/Dried Fruit ❑ Dried Fruit <br /> ❑ Salted Marshmallows/ <br /> Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars' <br /> Dried or <br /> ❑ Vegetarian- <br /> Vegetables ehydrated ❑ Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/EHD <br />