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CFO Zip: <br />qcvi, <br />CFO City: <br />(?)3o T_e}r r &c iiV Vr <br />CFO Physical Address: <br />SAN JOAQUIN <br />cou N <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFOtBusiness Name: <br />W4'y1 k,-ea\e., Owner Name: 1 l, i 6\ \luln Date: <br />Website (If applicable): Telephone: jo 0 71 <br />Categories: <br />"Class A" (Direct Sales Only) $456- <br />Prohibited Items: <br />0 "Class B" (Direct & Indirect Sales) $310 <br /> <br />Initial if you agree to abide by the following: <br /> <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-borne illness. <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />Dry Baking Mixes <br />Waffle Cones <br />0 Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />0 Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />(3 Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Fruit Butter** <br />0 Chocolate <br />Ground <br />Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />"Class A" Self Certification Checklist: <br />ID Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods • Dried Pasta O Honey <br />0 <br />Trail Mix/ Dried Fruit 0 Dried Fruit <br />Dried or Dehydrated <br />" Vegetables <br />1868 E. Hazelton Avenue I <br />1-7 Dried Vegetarian- <br />Based' Soup Mixes <br />Stockton, California 95205 <br />Vegetable and Potato Chips <br />T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD