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SO 10ARIN Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Neme: Owner Name t <br />PYRAMID Ng, <br />Mohamed A ouSamaha 4/ %2021 <br />CFO Physical Address: CFO City: CFO Zip: <br />1721 Duncan Rd. Tracy 95376 <br />Webske (If applicable): Telephone: / <br />(443) 220-4864 f. OLL , <br />1. Categories: <br />❑ "Class A" (Direct Sales Only) $155 SCJ "Class B" (Direct & Indirect Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: MA <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-bome illness. <br />3. "Class A" Self Certification Checklist: <br />❑ Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />X Baked Goods ❑ Dried Pasta <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Buttercream <br />❑ <br />Buttercream <br />❑ Trail Mix/ Dried Fruit <br />Frosting/Icing' <br />Dried Fruit <br />Fondant/Gumpaste' <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ Fruit Empanadas ❑ Fruit Tamales/Pies <br />❑ Granola/Cereals ❑ Seasoning Salt <br />IN Cotton Candy ❑ Candied Apples <br />❑ Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ Honey <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />El Popcorn <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter— <br />Ground <br />Chocolate <br />❑ Pizzeles <br />❑ <br />Jams/Jellies" <br />Nut Mixes/NutElFried <br />or Baked <br />❑ <br />Donund <br />Butters <br />Waffles <br />❑ Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted Marshmallows/ <br />El El ElMarshmallow <br />Bars' <br />❑ Vegetable and Potato Chips <br />186$ E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />