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SAK JOAQUIN Environmental Health Department <br /> " —COUNTY <br /> \c�Or Greatness grows here. <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 /> �}nno`s srr�srs �I465 . flim 64'e(-der— (01ca /;Z;�, <br /> CFO Physical Address: CFO City: CFO Zip: <br /> X848/ Pxrad�� " Toy <br /> Website(if applicable): Telephone: <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $155 J�r "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 be preparing and/or selling. <br /> Baked Goods ❑ Dried Pasta ElHoney Popcorn/ <br /> Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream Buttercream Ground <br /> ElFrosting/Icing* ❑ Fondant/Gumpaste* LlFlat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ El Donuts and <br /> Butters Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge Ef Marshmallow <br /> Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables ElDried <br /> Soup Mixes El Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/EHD <br />