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SAN JOAQUIN Environmental Health Department <br />—COUNTY <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Physical Address: <br />Website (If applicable): <br />✓\ -1.,. <br />Owner <br />CFO City: <br />Telephone: ( ' 1 O�) /j I �_ t4 <br />C <br />1. Cate oriel: �)n <br />"Class A" (Direct Sales Only) $155 <br />CFO zip: <br />�Y\ A d I(,% of C,0 4 0 .b (�_Z '5irf\0-0 . C -Try \ <br />❑ "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 AL 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 />❑ Baked Goods <br />❑ Candy <br />❑ Churros <br />❑ Buttercream <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 />E? Candied Apples <br />❑ Honey <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Popcorn/ <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter" <br />❑ Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ Jams/Jellies'" <br />Baked <br />E]Nut <br />Mixes/Nut <br />Donuts and <br />s <br />El Donuts <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />[v]" Dried Fruit <br />El Marshmallows/ <br />Salted E]Caramel/Fudge Barrsshmallow <br />Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br />Vegetables 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/EHD <br />