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SKJDQOUIN Environmental Health Department <br />F,I —COUNTY— <br />`., Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name <br />Owner Name: II Date. <br />i�i5,- ��h�in� S• hire b3%o /902 <br />CFO Physical Address: CFO CityCFO Zip: <br />15 6 2 P 44,5 T Lg -�- o rq,5,3 3 o <br />Website (If applicable) Telephone: � IS 9— G 0 (0 y3,c 6 C) <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: A' S' P <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. "C ass A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />4. <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 <br />Baked Goods <br />E] <br />Dried Pasta <br />[_1 <br />Honey <br />El <br />Popcorn Balls <br />Popcorn <br />❑ <br />Candy <br />L?' <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter— <br />❑ <br />Buttercream <br />❑ <br />Buttercream <br />❑ <br />Flat Icing <br />E] <br />Ground <br />Frosting/Icing' <br />Fondant/Gumpaste' <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <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 />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />❑ <br />Cotton Candy <br />❑ <br />Candied Apples <br />❑ <br />Salted <br />❑ <br />Marshmallows/ <br />Marshmallow <br />Caramel/Fudge <br />Bars' <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sigov org/ehd <br />