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SAN^JOQQUIN Environmental Health Department <br />—COUNTY— <br />`\ <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO <br />Website (If applicable): <br />Owner Name: <br />CFO <br />Date: n ,� 11 I Z <br />CFO Zip: <br />1. Catenories• <br />f"t '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-potentiany 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 />Baked Goods <br />❑ Candy <br />❑ Churros <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />fes+ Fondant(Gumpaste <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Sait <br />[I Candied Apples <br />Dried or DehydratedDried Vegetarian - <br />13 Vegetables E] Based Soup Mixes <br />El <br />Buttercream <br />11 <br />Frosting/Icing' <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />fes+ Fondant(Gumpaste <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Sait <br />[I Candied Apples <br />Dried or DehydratedDried Vegetarian - <br />13 Vegetables E] Based Soup Mixes <br />El <br />11 <br />Popcorn <br />Popcorn Balis <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter' <br />❑ <br />Flat Icing <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies- <br />Nut Mixes/Nut <br />C1Fr <br />orts Baked <br />Butters <br />nd <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />❑ <br />Salted <br />Marshmallows/ <br />Caramel/Fudge <br />Marshmallow <br />Bars' <br />❑ 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 />