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SANJQAQUIN Environmental Health Department <br />—COUNTY— <br />oa ureotness grows he-.: <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 />CA.acrl`t2Ca Q__&-Se6lL t_tux-G. Nf_wa OLAIA I90aa <br />CFO Physical Address: CFO City: CFO Zip: <br />� GchArtr�G. PC��SS'etri�. <br />1. Categories: <br />d "Class A" (Direct Sales Only) $155 <br />❑ "Class B" (Direct & Indirect Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: LXJ <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 />LA Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />dBaked Goods ❑ Dried Pasta ❑ Honey <br />❑ Candy <br />❑ Churros <br />EiButtercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />El Vegetables or Dehydrated <br />Vegetables <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 />❑ Dried Vegetarian - <br />Based Soup Mixes <br />❑ Mustard <br />❑ Dried Grain Mixes <br />dFlat Icing <br />❑ Pizzeles <br />El Butters Mixes/Nut <br />Butters <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter** <br />El <br />Chocolate 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 />❑ 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 />