Laserfiche WebLink
Owner Name: CFO Business Name: Date: <br />/0 <br />CFO Zip: <br />9533(47 <br />1i C eS- <br />CFO Physical Address. <br />I(07 Sanotr r S4- <br />Website (If applicabfe): <br />CFO City: <br />Teleph:21e.b —L/8-7 — W(03 <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: www.sigov.ord/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <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 <br />Foods containing cream, custard, or meat 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 />EKC-hecklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />D Baked Goods 0 Dried Pasta 0 Honey <br />V.. --Candy 0 Dry Baking Mixes 0 Mustard <br />0 Churros 0 Waffle Cones El Dried Grain Mixes <br />D Buttercream <br />Frosting/lcing* <br />0 Buttercream <br />FondanliGumpaste* E1 Flat Icing <br />0 Dried Mole Paste 0 Herb/Spice Blends 0 Pizzeles <br />0 Fruit Empanadas 0 Fruit Tamales/Pies CI Nut Mixes/Nut <br />Butters <br />0 Granola/Cereals 0 Seasoning Salt D Trail Mix/ Dried Fruit <br />El Cotton Candy Candied Apples El Salted <br />Caramel/Fudge <br />0 Popcorn/ Popcorn Balls <br />Vinegar <br />0 Fruit Butter** <br />ri Ground <br />Chocolate <br />Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />E1-10 16-276/2912023 <br />1 CFO REGIPERMfTTING FORM