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SAN JOAQUIN <br />CUNT.— - <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name Owns am Date: <br />�- d l S a �� Skov_- _171 V • ?u.& -l- l '2, 2Z 2k' <br />CFO Physi Address: CFO City: CFO Zip: <br />1'l3� LCy ay,1t c klr�/11, S �I tJ 9Q09Website (It applicable): V Telephone: ('Lot, ,,II r <br />)'T�I,Y'I-I <br />1. Categories: <br />g "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 <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 <br />foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food -borne illness. <br />3. "Class A" Self Certification Checklist: <br />4 Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling <br />ig Buttercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />13t Fruit Empanadas <br />❑ Granola/Cereals <br />0 Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />A Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />KFruit Tamales/Pies <br />❑ Seasoning Salt <br />X Candied Apples <br />❑ Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ <br />Baked Goods <br />Popcorn/ <br />Candy <br />l� <br />Churros <br />ig Buttercream <br />Frosting/Icing' <br />❑ Dried Mole Paste <br />13t Fruit Empanadas <br />❑ Granola/Cereals <br />0 Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />A Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />KFruit Tamales/Pies <br />❑ Seasoning Salt <br />X Candied Apples <br />❑ Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ <br />Honey <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />Flat Icing <br />❑ <br />Ground <br />Chocolate <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />❑ <br />Nut Mixes/Nut <br />Fried or <br />Butters <br />Donuts aBdked <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />d <br />Salted <br />Marshmallows/ <br />Marshmallow <br />A <br />Caramel/Fudge <br />Bars* <br />❑ Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgcv.org/EHD <br />