Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br />COUNTY— <br />COTTAGE <br />OUN v <br />Name: <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner <br />s rye <br />Date: <br />CFO Physical Address: CFO City: CFO Zip: <br />,� 4t C-\ ,r -r ili ArA C/Q eAC oa a S -D C V4W\1 9 S 7 (2 - <br />Website (If applicable): Telephone: <br />5l0 `101y s9.3I <br />1. Ca a ories: <br />ILK "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 O D. Only <br />foods that are defined as "non -potentially hazardous' are approved for preparation by a Cottage od O eration. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth the uld be a <br />cause of food-bome illness. <br />3. "Class A" Self Certification Checklist: <br />❑ Checklist completed <br />("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />opcorn/ <br />E`Baked Goods <br />ElDried Pasta <br />ElHoney <br />Popcorn Balls <br />Id Candy <br />❑ Dry Baking Mixes' <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ Churros <br />❑ Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />Buttercream* <br />Buttercream <br />El <br />Flat Icing <br />❑ <br />Ground <br />Frosting/Icing <br />Fondant/Gumpaste* <br />Chocolate <br />❑ Dried Mole Paste <br />❑ Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />Nut Mixes/Nut <br />Fried or Baked <br />El Fruit Empanadas <br />❑ Fruit Tamales/Pies <br />ElElButters <br />Donuts and <br />Waffles <br />❑ Granola/Cereals <br />❑ Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ Cotton Candy <br />Candied Apples <br />❑ <br />Caramel/Fudge <br />❑ <br />Marshmallow <br />Bars* <br />Dried or Dehydrated <br />❑ <br />Dried Vegetarian- <br />ElDried <br />❑ <br />Vegetable and Potato Chips <br />Vegetables <br />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 />