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SAN JOAQUIN COUNTY <br /> c)12054,3 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orci/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />e. 661.,s etiriP_J-i.As Ke_LIA, (1-i ai.tALAS 1/-2 S'--3 <br />CFO Physical Address: CFO City: ._. <br />9rnrh ri.i, 0 eb /4) • man-feak <br />CFO Zip: <br /> <br />Website (If applicab ): Telephone: 26 D <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: <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 />E4 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />// Buttercream <br />i* <br />rr/ B u tt e r c r e a m <br />441 * Er Flat Icing 0 <br />Frosting/Icing Fondant/Gumpaste <br />Ground <br />V Chocolate <br />0 Dried Mole Paste 0 Herb/Spice Blends 0 Pizzeles CI Jams/Jellies** <br />ried or Baked <br />Li Fruit Empanadas CI Fruit Tamales/Pies Nut Mixes/Nut <br />Butters Donuts and <br />Waffles <br />D Granola/Cereals 0 Seasoning Salt D Trail Mix/ Dried Fruit 0 Dried Fruit <br />"Salted Marshmallows/ Er 0 Cotton Candy 0 Candied Apples El Marshmallow Caramel/Fudge Bars* <br />EHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />tf Baked Goods 0 Dried Pasta 0 Honey <br />, <br />V1 Candy 0 Dry Baking Mixes 0 Mustard <br />0 p h u rro s 0 Waffle Cones 0 Dried Grain Mixes