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SAN JOAQL... <br />r_71 ,i r\ v <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner <br />e <br />Website (If applicable): Telephone: /► _ rM,, <br />Date: <br />5 <br />1. Categories: <br />b/ "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: Lid <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 />[/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 />ElButtercream <br />Frosting/Icing* <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 />Fondant/Gumpaste* <br />Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />5 Honey <br />❑ Mustard <br />Dried Grain Mixes <br />❑ Flat Icing <br />El <br />Pizzeles <br />❑ <br />Popcorn Balls <br />Popcorn <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter** <br />❑ <br />Ground <br />❑ <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />Fried Baked <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Donutss and <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />El Salted ❑ Marshmallows/ <br />Caramel/Fudge B r hmallow <br />❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br />Vegetables Based Soup Mixes <br />NnLeltun CAii o rn_ ?6i0) 1 T 200,1(',8-12.20 ! F <br />