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SAN JOAQUIN <br />—COUNTY— <br />Greatness grows herr <br />rAzv� r­-� P 2 <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATIONIPERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Businej Name: Owner Name: / 16 Date: <br />�&jC.G. <br />Sup/ir O( �Di(� �Kw u - SkXh11klo— tj3o� <br />CF Physical Address: CFO City: CFO Zip: <br />$ `i y o e ac 95-3 6 <br />website (If applicable): Tele hone: <br />�Q Sk�_q io22 <br />1. Cate Dries: Shan e(evim\e,-�c C<@ iY�c \. CASly-N <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: S V <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 andlor selling. <br />Baked Goods ❑ Dried Pasta ❑ Honey <br />❑ Candy <br />❑ Churros <br />❑ Buttercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />❑ Buttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Pizzeles <br />❑ Nut Mixes/Nut <br />Butters <br />E] Popcorn <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter** <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Jams/Jellies** <br />Fried or Baked <br />❑ <br />Donuts and <br />waffles <br />❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />Salted Marshmallows/ <br />❑ Caramel/Fudge ❑ Marshmallow <br />Bars <br />Dried or Dehydrated Dried Vegetarian - <br />Vegetables ❑ Based Soup Mixes ❑ 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.sigov-org/EHD <br />