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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: <br /> <br />o ,e4 <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 />10kPF--E ME- pAz ?, P-1 TIA 1\11 12,A111÷-1 e-1-1- 1 I I ch 12-14 <br />CFO Physical Address: CFO City: CFO Zip: <br />3 I r-/1A 12-1 E P— A PT —I 2— 2-0 ) C) 151 <br />Website (If applicable): S400C+On J 415‘2141 Telephone: <br />2-01) 40U -1511 <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: Pz. <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 />Checklist completed ("Class A" CFOs Only) <br />Products: <br />lZr <br />? <br />0 <br />0 <br />,21 <br />E l <br />Please check the items you will be preparing and/or selling. <br />Baked Goods gf Dried Pasta 0 Honey <br />Candy Dry Baking Mixes 0 Mustard <br />Churros 0 Waffle Cones 0 Dried Grain Mixes <br />Buttercream Buttercream <br />Frosting/Icing* 0 Fondant/Gumpaste* 21 Flat Icing <br />Dried Mole Paste 0 Herb/Spice Blends 0 Pizzeles <br />Fruit Empanadas 0 Fruit Tamales/Pies Nut Mixes/Nut 0 <br />Butters <br />Granola/Cereals 0 Seasoning Salt El Trail Mix/ Dried Fruit <br />yj, Salted Cotton Candy cZ Candied Apples Caramel/Fudge <br />Ey Popcorn/ <br />Popcorn Balls <br />E Vinegar <br />0 Fruit Butter*" <br />in Ground <br />' Chocolate <br />0 Jams/Jellies** <br />Fried or Baked J2' Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />END 16-27 6/29/2023 <br /> <br />1 CFO REG/PERMITTING FORM <br />pgo5LISIq