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.." <br />:. ,. <br />10 <br />F ° SANJOAQUIN <br />—COUNTY— <br />Greatness grows here. <br />CFO <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AS 1616 (GATTO)) <br />Address: <br />— t " <br />Website (If applicable): <br />Owner Name: <br />CFO City. <br />Date: FI III Z I <br />CFO Zip: <br />1. Catenaries: <br />N '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 and/or selling. <br />4a) Baked Goods <br />❑ Candy <br />❑ Churros <br />D� Buttercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />E]Dried <br />Pasta <br />ElHoney <br />❑ <br />Popcomi <br />PopcornBalis <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />vinegar <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter' <br />m5 <br />K�+ <br />Buttercream <br />❑ <br />Flat Icing <br />❑ <br />Ground <br />Fondant/Gumpaste' <br />Chocolate <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Fried or Baked <br />Butters <br />Waffles <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />❑ <br />Candied Apples <br />❑ <br />Salted <br />Marshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars* <br />❑ Dried or Vegetab es hydrated ❑ Based Soup Mixes Elried Vegetarian- Vegetable and Potato Chips <br />1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />C<S S <br />