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SANJOAQUIN <br />„L,, —COUNTY— <br />Greatness grows here. <br />CFO Business <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: <br />)�A"i' y)(A —unS <br />Date: <br />J <br />CFO Physical Address: CFO City: CFO Zip: <br />laol Oal rcw Df. Lcaywpp 85330 <br />Website (If applicable): Telephone: <br />1,..{ Categories: <br />lyl "Class K (Direct Sales Only) $186 ❑ "Class B” (Direct & Indirect Sales) $312 <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 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 />19 Checklist completed ("Class A" CFOs Only) <br />4. <br />Products: <br />❑ <br />Jams/Jellies** <br />Please check the items you will be preparing and/or <br />selling. <br />Fried or Baked <br />Baked Goods <br />❑ Dried Pasta <br />❑ Honey <br />❑ <br />Candy <br />❑ Dry Baking Mixes <br />❑ Mustard <br />❑ <br />Churros <br />❑ Waffle Cones <br />❑ Dried Grain Mixes <br />Buttercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />Buttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Flat Icing <br />❑ Popcorn/ <br />Popcorn Balls <br />❑ Vinegar <br />❑ Fruit Butter** <br />❑ Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />Nut Mixes/Nut <br />Fried or Baked <br />❑ <br />❑ <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted Marshmallows/ <br />❑ Caramel/Fudge ❑ Marshmallow <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 />fQO949 ?-N I S <br />