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/PA- D51/ 9231 <br /> SAN JOAQUIN Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO usiness Name' Owner Nyme. DOW( oafs v �ot ` __ I%Ichele l�ricn� _ /•3i a��73 <br /> CFOFtq l iMmBae: CFO City. CFO Zip: <br /> /981B AJ /Ppor1/?aac/ 2rpoil �a 9531010 <br /> Webs toappki ley Telephhona: qry p9 • 4 b'l• 7555 <br /> 1. Categories: <br /> S K '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: 1`4,y <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-bome illness. <br /> 3. "Class A"Self Certification Checklist: <br /> (a•Checklist completed('Class A'CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Baked Goods ElDried Pasta Honey ElPopcomf rn <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter' <br /> Buttercream ® Buttercream ❑ Flat Icing El Chocolate Frosting/icing' Fondant/Gumpaste' Chocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas El Fruit Tamales/Pies ButtersElDonuts and <br /> Waffles <br /> �J. Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars' <br /> 18661=Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 4646133 ( www-gam ingrerid <br /> S <br />