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few-('e ec <br />SAN JOAQUIN <br /> <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: <br />1Q_C \\QA,02 c‘NI tu;\ <br />Owner Name: Date: <br /> <br />CFO Physical Address: CFO City: <br />VV\l, -AOKA-1 e. <br />CFO Zip: <br />S 11 <br /> <br />Website (If applicable): Telephone: <br />TbC\ <br />Categories: <br />zd "Class A" (Direct Sales Only) $186 <br />Prohibited Items: <br />Cl "Class B" (Direct & Indirect Sales) $312 <br />Initial if you agree to abide by the following: .N2--\ <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 />/CI Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El <br />CI <br />CI <br />LI <br />CI <br />CI <br />CI <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 />El <br />El <br />CI <br />El <br />CI <br />CI <br />11 <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 />CI Honey <br />CI Mustard <br />El Dried Grain Mixes <br />Er Flat Icing <br />CI Pizzeles <br />Nut Mixes/Nut El Butters . <br />El Trail Mix/ Dried Fruit <br />El Salted <br />Caramel/Fudge <br />Popcorn/ El Popcorn Balls <br />El Vinegar <br />El Fruit Butter** <br />Ground El Chocolate <br />LI Jams/Jellies — <br />Fried or Baked <br />El Donuts and <br />Waffles <br />CI Dried Fruit <br />Marshmallows/ <br />ID 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