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SANAOAQUINp <br />Environmental Health Department <br />—COUNTY— <br />Greatness <br />COUNTY <br />Greatness grows here. <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 />tlunn� <br />We SUgar gQn6l b2slra2 G-D?p sisI2t <br />CFO Physical Address: CFO City: CFO Zip: <br />l b i sn "x0Y1 br . Stvactctr, , cA <br />Website (If applicable): Telephone: <br />ZOP- 040- <br />1. Categories: <br />,W "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 />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-bome 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 andlor selling. <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 />Baked Goods <br />El <br />Dried Pasta <br />El <br />Honey <br />El <br />Popcorn <br />Popcorn Balls <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />ButtercreamElButtercream <br />El <br />Flat Icing <br />❑ <br />Ground <br />Frosting/Icing* <br />Fondant/Gumpaste' <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies'" <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />[:]Donuts <br />Fried or Baked <br />and <br />Butters <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />❑ <br />Candied Apples <br />❑ <br />Caramel/Fudge <br />❑ <br />B r hmallow <br />❑ <br />Dried or Dehydrated <br />❑ <br />Dried Vegetarian- <br />❑ <br />Vegetable and Potato Chips <br />Vegetables <br />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 />