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SAN JOAQUIN Environmental Health Department <br />.1.111.... C O U <br />Gredtnn. , <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />Sugar Made Special <br />Owner Name: <br />Jordan Harless <br />Date: <br />1/18/2022 <br />CFO Physical Address: <br />CFO City: <br />CFO Zip: <br />2336 Grenoble Dr <br />Lodi <br />95242 <br />Website (If applicable): <br />Telephone: <br />Dry Baking Mixes <br />sugarmadespecial.com <br />209-747-4235 <br />❑ <br />1. Categories: <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: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT WED. 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 />9 Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Ea <br />Baked Goods <br />El <br />Dried Pasta <br />❑ <br />Honey <br />El <br />Popcorn Balls <br />Popcorn <br />® <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />Buttercream <br />Buttercream <br />Flat Icing <br />® <br />Ground <br />Frosting/Icing' <br />Fondant/Gumpaste' <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />❑ <br />Fruit Empanadas <br />® <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />El <br />Fried or Baked <br />Donuts and <br />gutters <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />® <br />Candied Apples <br />Caramel/Fudge <br />Marshmallow <br />Bars` <br />❑ <br />Dried or Dehydrated <br />❑ <br />Dried Vegetarian- <br />❑ <br />Vegetable and Potato Chips <br />Vegetables <br />Based Soup Mixes <br />1868 E Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sjgov.org/END <br />