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,SAN JOAQUIN <br />___COUNTY -- <br />v <br />Greatness grows here. <br />r--aw- Pln <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Nam�j Owner Name: Date: <br />e foodSdCu��y'sk`t��lQn �4S1�w'ini S- pjse I (5122 <br />CFO Physical Address: CFO City: - `q TrlZC7 p CFO Zip: 9 5,3 g <br />1562 PkUwco �) 2;_ - I J <br />Website (If applicable): Telephone: 6 n _ /' ©� _ 6 v <br />1. Categories: <br />"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: /1,7,1� <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 />Baked Goods <br />ElDried <br />Pasta <br />ElHoney <br />ElPopcorn/ <br />Popcorn Balls <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />4 <br />Dried Grain Mixes <br />❑ <br />Fruit Butter"* <br />❑ <br />Buttercream <br />❑ <br />Buttercream <br />❑Flat <br />Icing <br />❑ <br />Ground <br />Frosting/Icing* <br />Fondant/Gumpaste* <br />Chocolate <br />❑ <br />Dried Mole Paste <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />❑ <br />Fried or Baked <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Granola/Cereals <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />0 <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />❑ <br />Candied Apples <br />❑ <br />Caramel/Fudge <br />❑ <br />Marshmallow <br />Bars* <br />1868 <br />E. Hazelton Avenue <br />Stockton, California 95205 1 <br />T 209 468-3420 1 F 209 464-0138 <br />1 www.sjgov.org/ehd <br />r Ko Sri $30� <br />