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A. COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) c BusinesMame: Owner Na �}� ^ Dale: / 1 'f Ur"� a,"-\ 0,- 1(( A t / y 1 l c/ yC"'ci CFO Physical Address: CFO City: CFO Zip: Website (If applicable): Telephone: -50y 2C/ v sa�� 1. Categories: M ---Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 -( IN 2. Prohibited Items: Initial if you agree to abide by the following: 1" �`t t Foods containing cream, custard, or meat fillings are potentially hazardous and are NOTA6FooOperation. Only foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-bome illness. 3. "Class A" Self Certification Checklist: ❑ Checklist completed ("Class A" CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. /Baked Goods ❑ Candy ❑ Churros ElButtercream Fondant/Gumpaste* Frosting/Icing* ❑ Dried Mole Paste ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Cotton Candy ❑ Dried Pasta ❑ Dry Baking Mixes ❑ Waffle Cones ElButtercream Fondant/Gumpaste* ❑ Herb/Spice Blends ❑ Fruit Tamales/Pies ❑ Seasoning Salt ❑ Candied Apples ❑ Dried or Dehydrated ❑ Dried Vegetarian - Vegetables Based Soup Mixes [IHoney El Popcorn Popcorn Balls ❑ Mustard ❑ Vinegar ❑ Dried Grain Mixes ❑ Fruit Butter** ❑ Flat Icing ❑ Ground Chocolate ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut Fried or Baked ❑ El Donuts and Butters Waffles ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit ❑ SaltedMarshmallows/ ❑ Marshmallow Caramel/Fudge Bars* ❑ Vegetable and Potato Chips