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CFO Business Name: Owner Name: <br />f\AOLYA t iS t1/4ACkaV-OVAS Piwytivran Irdt <br />CFO Physical Address: CFO City: <br />tkt -Ciovc-A Rzmexel-1-cc r - <br />Date: <br />Up' —?""0 3 <br />CFO Zip: <br />CiS?-05 Crt- <br /> SAN JOAQUIN <br />,odisL.arri <br />,..11-,Foe, Greatness grows here. <br />Environmental Health Department <br />COUNTY <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Website (If applicable): Telephone: <br />00ai,— <br />Categories: <br />"Class A" (Direct Sales Only) $186 LI "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: <br />Foods <br />- <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 />l% 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 />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />1=1 Dried Pasta <br />LI Dry Baking Mixes <br />111 Waffle Cones <br />Fr—lauttefefeem <br />,—Flarteliati4Gumpaste <br />111 Herb/Spice Blends <br />LI Fruit Tamales/Pies <br />n Seasoning Salt <br />1=1 Candied Apples <br />I=1 <br />LI <br />El <br />El <br />111 <br />ri <br />'I <br />1=1 <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />LI Popcorn/ <br />Popcorn Balls <br />D Vinegar <br />111 Fruit Butter** <br />LI Ground <br />Chocolate <br />El Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />111 Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I vvww.sjgov.org/ehd <br />I=1 <br />111 <br />ID <br />El <br />1=1 <br />Li