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CFO Physical I:217s <br />1 1 /7 fi pr <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvovw sigov orq/EHD <br /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />LF0 <br />I/cry-7%/v [Kee 2e- /fri Name o PI 3/z3 <br />, Bu5iness Name Owner Name Date <br />ren <br /> <br />CFO ity.c2y <br />Wel:mite (If applicable) <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: <br />Foods containing cream, custard, or moat fillings are potentially hazardous and are NOT ALLOWED <br />Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br />Operation These foods include items that do not require refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness <br />"Class A" Self Certification Checklist: <br />ci Checklist completed (-Class A" CFOs Only) <br />Products: <br />P/ease check the items you will be preparing and/or selling. <br />EJ <br />0 <br />0 <br />0 <br />0 <br />C1 <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 Dried Pasta <br />X Dry Baking Mixes <br />Waffle Cones <br />,—, Buttercream <br />LJ FondantiGumpaste <br />gi Herb/Spice Blends <br />El Fruit Tamales/Pies <br />0 Seasoning Salt <br />r0 Candied Apples <br />0 Honey <br />El Mustard <br />X Dried Grain Mixes <br />0 Flat Icing <br />0 Pizzeles <br />0 <br />Nut Mixes/Nut <br />Butters <br />0 Trail Mix! Dried Fruit <br />ail <br />Salted <br />Caramel/Fudge <br />Popcorn/ 0 Popcorn Balls <br />Vinegar <br />0 Fruit Butter — <br />,—, Ground <br />Li Chocolate <br />CI Jams/Jellies — <br />Fried or Baked <br />El Donuts and <br />Wattles <br />2 Dried Fruit <br />Marshmallows/ <br />_,V Marshmallow <br />Bars' <br />I riU it 'di trzwifit ti 0 K6411401 IINU FORM <br />CFO City <br />c1, <br />9zc- 7Z -k?D Telephone: