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co <br />SQNJOAQUIN Environmental Health Department <br />" �If ` —COUNTY <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFOusiness+Name: Owner Name: �Date: Z.3 2 <br />�` S CU�tiF'« br"p-e. �1n �-`� 1p <br />CFO 1Physical Ad. ccc, l 1, (t ,e CFO City: <br />��� CFO� s z- IS <br />Website (If applicable): Telephone: n do 50111—W11 <br />1. Categories: <br />"Class A" (Direct Sales Only) $155 <br />❑ "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 -borne illness. <br />3. "Class A" Self Certification Checklist: <br />Q�Checklist completed ("Class A" CFOs Only) <br />4. (Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods ❑ Dried Pasta ❑ Honey <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />F, Cotton Candy <br />IDry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />(J <br />Fonda nt/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />Candied Apples <br />❑ <br />Candy <br />❑ <br />Churros <br />,Z42 <br />(E❑ <br />Buttercream <br />Frosting/Icing* <br />Pizzeles <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />F, Cotton Candy <br />IDry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />(J <br />Fonda nt/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />Candied Apples <br />❑ <br />Mustard <br />❑ <br />Dried Grain Mixes <br />,Z42 <br />(E❑ <br />Flat Icing <br />Pizzeles <br />El <br />Mixes/Nut <br />Butters <br />Butters <br />❑ <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />truer Popcorn/ <br />(J� Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter*" <br />El Chocolate Chocolate <br />❑ Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />❑ Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables ElDried <br />Soup Mixes El 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 />