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r,.Q�- n 4P_� e2 SAN JOAOOIN Environmental Health Department COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) W,Wa nr appnmdel: 1. Cate ories: t v-�•, I �P "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct 8 Indirect Sales) $310 t914 -12I qT--93Z) 2. Prohibited Items: Initial N you agree to abide by the following: (I YI Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non-polentially hazardous" are approved for preparation by a Canoga Food Operation. These foods include dams Nat do not require refrigeration to keep Nem safe from bacterial growth that could be a cause of food -borne illness. 3. "CIa A" Self Certification Checklist: Checklist completed ("Class A' CFOs Only) 4. Products: Please check the items you will be prepanng andlorselfing ❑ Baked Goods ❑ Dried Pasta 0; --'Candy ❑ Dry Baking Maes ❑ Charms ❑ Waffle Cones ❑ Buttercream ❑ Butlercream Frosting/Icing' ❑ Fondant/Gumpaste' ❑ Dried Mole Paste ❑ Hem/Spice Blends ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Granola/Cereals ❑ Conon Candy ❑ Seasoning Salt ❑ Candied Apples ❑ Dried or Dehydrated [3 Dried Vegetanar. Vegetables Based Soup Mixes ❑ Honey ❑ Popcom/ Popcom Balls ❑ Mustard ❑ Vinegar ❑ Dried Grain Mixes ❑ Fruit Butter" ❑ Flat Icing ❑ Ground Chocolate ❑ Finales ❑ Jams/Jellies'- Fred or Baked MixesMul ❑ E]Nut Donuts and Butters Waffles ❑ Trail MW Dried Fruit ❑ Dried Fruit ❑ SaltedMarshmallowsl ❑ Marshmallow Caramel/Fudge Barn' ❑ Vegetable and Potato Chips 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov orgfEHD