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°= c° SANA0A0UIN <br />—COUNTY <br />°pis oa F` Greatness grows here. <br />�i\'\ Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Q Owner ame: _ Dale; <br />laG$ E Naze, <br />*CFO Physical Arddress: CFQ City: CFO Zip: <br />Website (If applicable): / Telephone: <br />(5/69)55T- 7A17 <br />1. Categories: <br />X"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 -borne illness. <br />3. <br />"Class A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />4. <br />Products: <br />Please check the items <br />you will be preparing and/or <br />selling. <br />Baked Goods <br />E]Dried Pasta <br />❑ <br />Honey <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Candy <br />❑ Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />Buttercream <br />Buttercream <br />El <br />E] <br />Flat Icing <br />EllChocolate <br />Ground <br />Frosting/Icing" <br />Fonda nt/Gumpaste* <br />❑ <br />Dried Mole Paste <br />❑ Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />❑ <br />Fruit Empanadas <br />❑ Fruit Tamales/Pies <br />❑gutters <br />Nut Mixes/Nut <br />ElDonuts <br />Fried or Baked <br />and <br />Waffles <br />X <br />Granola/Cereals <br />❑ Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />❑ Candied Apples <br />❑ <br />Caramel/Fudge <br />❑ <br />Marshmallow <br />Bars' <br />❑ <br />Dried or Dehydrated <br />Dried Vegetarian- <br />ElDried <br />❑ <br />Vegetable and Potato <br />Chips <br />Vegetables <br />Soup Mixes <br />1868 <br />E. Hazelton Avenue I <br />Stockton, California 95205T <br />209 468-3420 F 209 464-0138 <br />1 www.sjgov.org/EHD <br />PDA jj35 <br />