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SAN lOAQIIIN <br />Environmental Health Department <br />, <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 />SCYyw1P ctxhd !� (o • A\\i )o yt FccAD r U 31 LIX <br />CFO Physical Address: CFO City: CFO Zip: <br />tZo(63 N - ii (( F-4- ?-1?0Y), L4 C1S3t)U <br />Website (If applicable: Telephone <br />W V W <br />v • (,W V� • (A v✓� � ✓ <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: /6l� <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 />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ <br />Candy <br />❑ <br />Churros <br />❑ <br />Buttercream <br />Frosting/Icing' <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ <br />Dry Baking Mixes <br />❑ <br />Waffle Cones <br />❑ <br />Buttercream <br />Fondant/Gumpasle' <br />❑ <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 />Honey <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter' <br />❑ <br />Flat Icing <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies"" <br />Fried r <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Trail MW Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Caramel/Fudge <br />❑ <br />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 />Pio S� O KI -T eS <br />