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"zU`Jcs` SAN d0AQUINa <br /> Environmental Health Department <br /> —COUNTY-- <br /> tireatness grows herr. <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 /> KriJtGn'✓ Gookir✓ �riftrn fjM0r77-4 01/oq/2,2 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 5g97 DvrhRrrl Fury 94- Try IJ 9530¢ <br /> Website(If applicable): Telephone:64 11) 5-17,/q y% <br /> 1. Categories: I <br /> Y "Class A" (Direct Sales Only)$155 "Class B" (Direct& Indirect Sales)$310 <br /> t <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-bome illness. <br /> 3. "Class A" Self Certification Checklist: <br /> to Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Pr Baked Goods E] Dried Pasta El Honey ElPopcom/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream y Ll Flat Icing El Ground <br /> Frosting/Icing` Fondant/Gumpaste Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies`" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trall Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ElCotton Candy ElCandied Apples ❑ Caramel/Fudge El Bars hmallow <br /> ❑ Dried or Dehydrated E] Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based 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/END <br />