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SAN JOAQUIN <br />—COUNTY— <br />kGreatness grows her <br />Nv,-.J- (N } i K <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />r'Sn ,S',,j> e l0 3ont YYIa�G��c1vCtG Z 1-71 Z-7 <br />CFO Physical Address: CFO City: CFO <br />►-Sc0 11cky+we 1I Lwi _Vcac�; S31 <br />Website (If applicable): Telephone: <br />l')IIN Z 0 q q I�I <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 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 />IJ Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />❑ Fruit Empanadas <br />E Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />9/' Waffle Cones <br />�uttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Dried or Dehydrated ❑Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />[SY' Honey <br />Baked Goods <br />Candy <br />1`1 <br />� 2" /Popcorn <br />Vinegar <br />❑ <br />Churros <br />dButtercream <br />❑ Ground <br />Frosting/Icing* <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />E Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />9/' Waffle Cones <br />�uttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Dried or Dehydrated ❑Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />[SY' Honey <br />E9/T�opcorn/ <br />Balls <br />,_,/ <br />2 Mustard <br />� 2" /Popcorn <br />Vinegar <br />❑/ Dried Grain Mixes <br />❑ Fruit Butter** <br />Ly Flat Icing <br />❑ Ground <br />Chocolate <br />Pizzeles <br />Jams/Jellies** <br />Nut Mixes/Nut <br />,Fried or Baked <br />Donuts and <br />Butters <br />Lj <br />Waffles <br />Trail Mix/ Dried Fruit <br />ffDried Fruit <br />Salted <br />❑/EK <br />Jv}arshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars* <br />Vegetable and Potato Chips <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 />FK65�Lfls3_7 S <br />