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SAN JOAQUIN EnvlronmenW Health Department <br />—COUNTY <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: p� Owner Name: Date: <br />Pat) Freeze Fun r_Isfie L.1AI6gyy`;- 1D15 -I Z0 ?_-Z <br />CFO Physical Address: CFO City: CFO Zip: <br />N052 Ckernenbr%e- Grt". l c_'r^rvp X5330 <br />Website (If applicable): Telephone: <br />Nl& 2oci-3S "17-2-1 <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 <br />❑ "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: - ✓/Lx) <br />Foods containing 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 />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 />❑ <br />Baked Goods <br />❑ <br />Candy <br />❑ <br />Churros <br />ElButtercream <br />Frosting/Icing* <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ <br />Dried Pasta <br />❑ <br />Honey <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />❑ <br />Buttercream <br />❑Flat <br />Icing <br />❑ <br />Ground <br />Fondant/Gumpaste* <br />Chocolate <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Fried or Baked <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />❑ <br />Candied Apples <br />❑ <br />Salted <br />❑ <br />Marshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars* <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 />ff__o,�4%6qq <br />S <br />