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SAN. JOAQUIN <br />—COUNTY— <br />Greatness grows here. <br />CFO Business Name: <br />Macks I Macs <br />F\ (? \�, \� <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: <br />Mackenna Jenson <br />Date: <br />0512312022 <br />CFO Physical Address: CFO City: CFO Zip: <br />262 Ramona Way Tracy 95376 <br />Websfte (If applicable): Telephone: <br />510a133133 fnfS � e-n�n 2 V <br />1. Categories: \- L <br />0 "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: MH <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 -tome 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 />0 Baked Goods <br />❑ <br />Candy <br />❑ <br />Churros <br />® <br />Buttercream <br />❑ <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 />ElButtercream <br />Mustard <br />❑ <br />Fondant/Gumpaste' <br />❑ <br />Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />[j Seasoning Salt <br />❑ Candied Apples <br />❑ Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />E]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 />2� <br />Jams/Jellies" <br />Baked <br />El <br />Nut Mixes/Nut <br />El <br />s <br />Donuts and <br />Donuts <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Marshmallows/ <br />El <br />Salted <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 />