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SAN JOAQUIN Environmental Health Department <br />CFO Business Name: <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: <br />Date: <br />J <br />CFO Physical Address: CFO City: CFO Zip: <br />'9 �1sa iv1C ct ✓\ jr Skoc};i()A %X09 <br />Website (If applicable): Telephone: <br />&n- IOGO <br />1. C to ories: <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: <br />GUS <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 />t!J' Baked Goods <br />[V Candy <br />❑ Churros <br />Buttercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried or Dehydrated <br />Vegetables <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />Fonda nt/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Dried Vegetarian - <br />Based Soup Mixes <br />❑ Honey <br />❑ Mustard <br />❑ Dried Grain Mixes <br />[Flat Icing <br />❑ Pizzeles <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter" <br />El <br />Chocolate Chocolate <br />❑ <br />Jams/Jellies"' <br />Fried or Baked <br />❑ Nut Mixes/Nut ❑ Donuts and <br />Butters Waffles <br />❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />®/ Salted marshmallows/ <br />Caramel/Fudge Marshmallow <br />Bars` <br />❑ 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 />