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Honey LII <br />Mustard El Vinegar <br />Dried Grain Mixes El Fruit Butter** <br />Flat Icing Eli <br />Pizzeles El Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />Trail Mix/ Dried Fruit El Dried Fruit <br />Popcorn/ <br />Popcorn Balls <br />Ground <br />Chocolate <br />Nut Mixes/Nut <br />Butters <br />1--1 Salted <br />Caramel/Fudge <br />Marshmallows/ <br />LI Marshmallow <br />Bars* <br />SAN JOAQUIN <br />---i- <br />COUNTY <br />c'il"Cr4irt,,o9,t‘,1" Greatness grows here. <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: f, Owner Name: <br />\1\kkA\ eC-Alt)/A ‘Amhef \\IUnI <br />CEO Physical Address: CFO City: <br />2k--) C.o,v) (kv,t, to:u <br />Date: <br />2. 271 ZS <br />CFO Zip: <br />615 2vi <br />Website (If applicable): Telephone: <br />'2—() `-) -1(12 )S 3 SF.) <br />Categories: <br />IYA, "Class A" (Direct Sales Only) $186 111 "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-borne illness. <br />"Class A" Self Certification Checklist: <br />111 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods <br />Candy <br />111 Churros <br />Buttercream <br />Frosting/Icing* <br />II] Dried Mole Paste <br />El Fruit Empanadas <br />111 Granola/Cereals <br />LI Cotton Candy <br />El Dried Pasta <br />111 Dry Baking Mixes <br />LI Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />LI Herb/Spice Blends <br />LI Fruit Tamales/Pies <br />111 Seasoning Salt <br />LI Candied Apples <br />LI LI <br />1868 E Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd