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SAN JOAQUIN <br />COU N -Y <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Business Name: Owner Name: Date: <br />CFO Physical Address: — CFO City: CFO Zip: <br />UC65 0 N,rYICrW >i0.Ca. ` ik- k tnyn Ctl;521tl <br />Website (If applicable): Telephone: <br />ww4j • Ct'i,Lm u . ao,-k 0-o l vv n rto nope riiv a MOLD 1, co "1 <br />1. Categories: <br />Class A" (Direct Sales Only) $155 <br />❑ "Class B" (Direct & Indirect Sales) $310 <br />2. Prohibited Items: Initial ff you agree to abide by the following: Qai — <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 />1vJ Baked Goods ❑ Dried Pasta ❑ Honey <br />V/ Candy <br />❑ Churros <br />Buttercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />Fondant/Gumpaste' <br />❑ Herb/Spice Blends <br />[/ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Cotton Candy f✓J Candied Apples <br />❑ Dried or Dehydrated ❑Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ <br />Mustard <br />❑/ <br />Dried Grain Mixes <br />yQ Flat Icing <br />❑ <br />Pizzeles <br />❑ <br />Nut Mixes/Nut <br />Butters <br />El <br />Popcorn Balls <br />Popcorn <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter" <br />El <br />Chocolate Chocolate <br />❑ <br />Jams/Jellies" <br />Fried or Baked <br />❑ <br />Donuts and <br />Waffles <br />❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />Salted Marshmallows/ <br />❑ Caramel/Fudge ❑ Marshmallow <br />Bars' <br />❑ Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />