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Trail Mix/ Dried Fruit Di <br />El Salted <br />Caramel/Fudge <br />SAN JOAQUIN <br /> <br />Environmental 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: <br /> <br />Owner Name: <br /> <br />Date: <br /> <br />RTh-epok "itIons VA) <br /> <br />130-0 .1 0-1,tx <br /> <br />CFO Zip: <br />95330 <br />CFO Physical Address: <br />0-0 O wrOW Of- <br />Website (If applicable): <br /> <br />CFO City: <br />Lath ro p <br />Telephone: <br />CGte 5151514 <br /> <br />Categories: <br />"Class A" (Direct Sales Only) $186 <br /> 0 "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: <br />Foods containing 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 />"Class A" Self Certification Checklist: <br />TA Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />lit Baked Goods <br />El Candy <br />El Churros <br />Buttercream <br />Frosting/Icing* <br />(=I Dried Mole Paste <br />El Fruit Empanadas <br />El Granola/Cereals <br />ci Cotton Candy <br />El Dried Pasta <br />El Dry Baking Mixes <br />0 Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />ID Herb/Spice Blends <br />ID Fruit Tamales/Pies <br />ci Seasoning Salt <br />0 Candied Apples <br />ci Honey <br />c-j Mustard <br />El Dried Grain Mixes <br />El Flat Icing <br />D Pizzeles <br />El <br />El <br />El <br />ci Popcorn/ <br />Popcorn Balls <br />ci Vinegar <br />Fruit Butter' <br />Ground <br />Chocolate <br />Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshm allows/ <br />Marshmallow <br />Bars* <br />Nut Mixes/Nut <br />Butters <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd