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r\e,,,j - <br />(\e�P_(A P2 <br />SANJOAQUIN Environmental Health Department <br />—COUNTY— <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />FOBusiness N me: Owner Name: I IIyy�� 1f Date: / <br />) I <br />LA e_ 05e 13c ker., �C4 Iiq F `4n l 1. 1--c rrlorl 7l is/aa <br />CFO Physical Address: CFO City: CFO Zip: <br />1007 -Mo-r;nec-s Cv Lc�r2e 95330 <br />Website (If applicable): Telephone: <br />��z�9i X78 9�s� <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: k AA t- <br />Foodscontaining cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br />that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food -borne illness. <br />b\1,ke_Cose b(7,\e-er j wed <br />3 "CI A" S If C rt'f' t' Ch kl' t <br />ass e e i tca lon ec Is . <br />Checklist completed ("Class A" CFOs Only) <br />CAYOA <br />4. <br />Products: <br />Please check the items <br />you will be preparing and/or <br />selling. <br />U <br />Baked Goods <br />El <br />Dried Pasta <br />El <br />Honey El <br />Popcorn Balls <br />Popcorn <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard ❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes ❑ <br />Fruit Butter** <br />Buttercream <br />❑ <br />Buttercream <br />a <br />Flat Icing El <br />Ground <br />Frosting/Icing* <br />Fondant/Gumpaste* <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles ❑ <br />Jams/Jellies** <br />Nut Mixes/Nut <br />Fried or Baked <br />®Fruit <br />Empanadas <br />�( <br />Fruit Tamales/Pies <br />Elgutters <br />El <br />Donuts and <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit ❑ <br />Dried Fruit <br />❑ <br />Cotton Candy <br />ElCandied <br />Apples <br />Salted <br />❑ <br />Marshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars* <br />1 RRR <br />F Havaltnn Ayanna I <br />Ctnrlrfnn r.nlifnrnin QF9nr I <br />T 9nQ dRR_'AA9n I F 9nQ iF;A_nl RR <br />I unenm cinnv nrn/ahrl <br />46S41%3 S <br />