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SAN JOApUIN p <br />Environmental Health Department <br />v;< ----COUNT Y--- <br />=�,,,4„r Greatness grows here. <br />CFO Business Name: <br />M., r oo k; e <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: Date: <br />stela Moreno—CAlzadilla <br />CFO Physical Address: CFO City: CFO Zip: <br />4(o9 ralenbriar Cjrcke Trgcy 953'77 <br />Website (If applicable): Telephone: <br />C78-7)413-1154 <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 />❑ Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods <br />❑ Candy <br />❑ Churros <br />L1Buttercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />X Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />2 Dry Baking Mixes <br />❑ Waffle Cones <br />ElButtercream <br />Fondant/Gum paste* <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 />El <br />El <br />Popcorn <br />Popcorn Balls <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />E] <br />Flat Icing <br />El <br />Chocolate Chocolate <br />❑ <br />Pizzeles <br />Jams/Jellies** <br />Fried or Baked <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Donuts and <br />Butters <br />Waffles <br />Trail Mix/ Dried Fruit <br />, <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />❑ <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 />