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CFO Business <br />SAN 10AQUIN <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Name: <br />Date: <br />�1—��- <br />CFO Physical Address: CFO City: CFO Zip: <br />Ovly2 N. SY)e\ion Rd . U Aden G517 64 <br />Website (If applicable): Telephone: <br />209- Mi- 65 bc( <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: 17F <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 />Q/Baked Goods ❑ Dried Pasta ❑ Honey <br />❑ Candy <br />❑ Churros <br />ElButtercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />❑ Buttercream <br />Fonda nt/Gum paste* <br />❑ Herb/Spice Blends <br />❑ <br />Mustard <br />❑ <br />Dried Grain Mixes <br />❑ <br />Flat Icing <br />❑ Pizzeles <br />El Popcorn <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter" <br />El Chocolate Chocolate <br />❑ Jams/Jellies" <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Fried or Baked <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit ❑ <br />Dried Fruit <br />❑ <br />Cotton Candy <br />❑ <br />Candied Apples <br />❑ <br />Salted <br />❑ <br />Marshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars' <br />❑ <br />Dried or Dehydrated <br />E] <br />Dried Vegetarian- <br />❑ <br />Vegetable and Potato Chips <br />Vegetables <br />Based Soup Mixes <br />1868 <br />E. Hazelton Avenue I <br />Stockton, California 95205 1 <br />T 209 468-3420 1 F 209 464-0138 <br />1 www.sjgov.org/EHr <br />