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. SAN J O A Q U (N Environmental Health Department <br />- courJrV <br />CFO Business <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: �kOm;,�pfCK- Date: u I (p 12! <br />3 :r —n <br />CFO Physical Address: VgI-A36 \D f (_- Ur CFO Cdy: V j-,)C�9,e CFO Zip: C S-L11J8 <br />Website (If applicable): <br />1. Categories: <br />P1 "Class A" (Direct Sales Only) $155 <br />Telephone: ( , j J46) (P Z --J — -A 2.q O <br />❑ "Class B" (Direct & Indirect Sales) $310 <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 />❑ Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will he preparing and/or selling. <br />Ly Baked Goods ❑ Dried Pasta ❑ Honey <br />❑ Candy <br />❑ Churros <br />❑ Buttercream <br />Frosting/Icing` <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />Granola/Cereals <br />❑ Cotton Candy <br />❑ DryBaking Mixes <br />❑ Waffle Cones <br />❑ Buttercream <br />Fonda nt/Gumpaste` <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />E] Popcorn <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter" <br />❑ Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies'* <br />Mixes/Nut <br />Fried or Baked <br />El <br />Donuts and <br />Butters <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted Marshmallows/ <br />❑ Caramel/Fudge ❑ Marshmallow <br />Bars* <br />Dried or Dehydrated Dried Vegetarian- <br />❑ Vegetables E)Dried <br />Soup Mixes ❑ 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 />