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Business <br />dip os"y 6 s"6R <br />SAN JOAQUIN Environmental HealtKb"WT t <br />SEP Z 1 2020 <br />ENl IRONMEN JAL 11LAL141 <br />COTTAGE FOOD OPERATIONS (CFO) DIA ARI NIENT <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: <br />Date: <br />CFO Physical Address: CFO City: CFO Zip: <br />2'z;1 Yy � • P -AV JL \1' C F�:\ <br />Website (If applicable): Telephone: <br />Il_ClL <br />1. Categories: <br />wZ "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 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 />❑ <br />Baked Goods <br />El <br />Dried Pasta <br />El <br />Honey <br />11 <br />Popcorn <br />Popcorn Balls <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 />❑ <br />Buttercream <br />❑ <br />Buttercream <br />❑ <br />Flat Icing <br />El <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 />Nut Mixes/Nut <br />Fried or Baked <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />gutters <br />Donuts and <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />Trail Mix/ Dried Fruit <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />❑ <br />Candied Apples <br />❑ <br />❑ <br />Marshmallow <br />Caramel/Fudge <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/EHD <br />S <br />