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<br />SANJOAQUIN <br />COUNTY <br />Environmental Health Department <br />tness grows here. b 2023 <br />ENVIRON oLiv ii,L IL <br />COTTAGE FOOD OPERATIONS (CFO) PERMIT/SERVICE <br /> <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />G;4e_ Owner Name: <br />/ Gad-/ F-11L, <br /> Date: 9/i5 <br />CFO Physical Address:C FO City: CFO Zip: <br />47//6 gii/Y <br />VVebsite (If applicable): Telephone: <br />6 i//e4 rrA Ire e _ (v) ) 4,74eZ- —5'5c(Z <br />Categories: <br />"Class A" (Direct Sales Only) $186 E "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: if-- <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 />'p Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 <br />E <br />E <br />1 E1 <br />0 <br />0 <br />0 <br />0 <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 />0 <br />0 <br />0 <br />E <br />E <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />E <br />E <br />E <br />0 <br />0 <br />LI <br />ri <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 />El <br />Popcorn/ <br />Popcorn Balls <br />E Vinegar <br />0 Fruit Butter** <br />Ground Li <br />Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />E 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