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PR_Ost -i033 <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />ooztdoor8 <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />Mn6-11( <br />CFO Physical Address: <br />az! KEIQ 11%/6 ST <br />Owner Name: <br />MEFHPIKI IRuKuLl_h <br />CFO City: <br />-TRAcy <br />Date: <br />‘M f1:2 3 <br />CFO Zip: <br />41 5 r31'7 <br />Website applicable). <br />Categories: <br />Ice "Class A" (Direct Sales Only) $186 <br />Prohibited Items: <br />Telephone: <br />C-1 2)-D —14-16 13? 6 <br />0 "Class Er (Direct & Indirect Sales) $312 <br />Initial if you agree to abide by the following: M <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 />\VI/Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />\VZ( Baked Goods <br />0 Candy <br />LII Churros <br />Buttercream <br />Frosting/Icing* <br />LI Dried Mole Paste <br />El Fruit Empanadas <br />El Granola/Cereals <br />0 Cotton Candy <br />0 Dried Pasta <br />LI Dry Baking Mixes <br />El Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />El Herb/Spice Blends <br />0 Fruit Tamales/Pies <br />0 Seasoning Salt <br />ci Candied Apples <br />El Popcorn/ <br />Popcorn Balls <br />Li Mustard El Vinegar <br />El Dried Grain Mixes 0 Fruit Butter** <br />0 Flat Icing <br />LI Pizzeles 0 Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />0 Trail Mix/ Dried Fruit <br />ri Salted <br />Caramel/Fudge <br />El Honey <br />Ground <br />Chocolate <br />Nut Mixes/Nut <br />'I Butters <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd