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S A 6J OA N I N Environmental Health Department <br />COUNTY— <br />Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Name: <br />Date: <br />S� 331 2 <br />CFO Physical Address: CFO City: CFO Zip: <br />801 W VJ;110W St- S+8CILtw C1520_� <br />Website (If applicable): Telephone: <br />(ZO-1) 4/ 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: <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 -home illness. <br />3. "Class 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 />® <br />Baked Goods <br />El <br />Dried Pasta <br />El <br />Honey <br />El <br />Popcorn Balls <br />Popcorn <br />❑ <br />Candy <br />❑ <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 />IN <br />Buttercream <br />❑Buttercream <br />EJ <br />Flat Icing <br />❑ <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 />Fried or Baked <br />© <br />Fruit Empanadas <br />® <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />C] <br />Donuts and <br />Butters <br />Waffles <br />I� <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />© <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />ElCandied <br />Apples <br />❑ <br />Caramel/Fudge <br />® <br />Marshmallow <br />Bars <br />1868 E. Hazefton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br />