Laserfiche WebLink
J, <br />pUly � <br />SANJQAQUIN Environmental Health Department <br />—COUNTY— <br />t' Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />(�yr✓rCUt1en5 <br />CFO Business Name: 11 Owner Name: Da <br />1h aft mom Im"IAi1 0r q /a-7 jU?_j <br />CFO Physical Address: CFO City: CFO Zip: <br />jup� sbachv\ OU -0 <br />Website (If applicable): Telephone: <br />Zo%v o2v233 <br />1. C to ories: <br />"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: N� D <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 />tJ <br />Baked Goods <br />�.,/ <br />t9' <br />Candy <br />❑ <br />Churros <br />ElButtercream <br />Popcorn Balls <br />❑ <br />Frosting/Icing* <br />❑ <br />Dried Mole Paste <br />❑ .. Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Dried Pasta <br />EKDry Baking Mixes <br />❑ Waffle Cones <br />E]Buttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Cotton Candy ❑ Candied Apples <br />❑ Dried or Dehydrated ❑Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ <br />Honey <br />H <br />El <br />Popcorn Balls <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 />Fried or Baked <br />❑ <br />El <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />El <br />El <br />Marshmallow <br />Bars* <br />❑ <br />Vegetable and Potato <br />Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br />