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SAN,JOAQUIN Laide <br />O sq 305 <br />Environmental Health Departmer <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATT0)) <br />CFO Business Name. <br />/3 (2..4 <br />CFO Physical Address: <br /> <br />°rimer Name <br />I _12_,T ,3 t r <br /> <br />CFO City: CFO Zip <br />t: _ y ci <br />Telephone: <br />575Y/ts-C <br />,-eci_sf - S <br /> <br />Wet:1sec (If applicable): <br /> <br />0 "Class 8" (Direct & Indirect Sales) $310 <br />Initial if you agree to abide by the following: 04____111i <br />Foods containing cream. custard, or meat fillings are potentially hazardous and are NOT ALLOWED Onil. <br />foods that are defined as "non-potentially hazardous- are approved for preparation by a Cottage Food Operatihr <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that coulo o. <br />cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />Thecklist cornoleteo Class A CFOs 0!)Iy1 <br />Products: <br />Please check the items you will he preparing and/or selling <br />Categories: <br />Class A (Direct Sales Only) $155 <br />t'A <br />Prohibited Items: <br />Caney j Dry Baking Mixes <br />fl churros E Waffle Cones <br />Suttercream Buttercream <br />Frosting/Icing' <br /> Fondant/Gumpaste* <br />tj.red Mole Paste 0 Herb/Spice Blends <br />Fruit Empanadas El Fruit Tamales/Pies <br />Granola/Cereals 0 Seasoning Salt <br />Cotton Candy Candied Apples <br />mustard <br />Dried Grain Mixes <br />Flat Icing <br />Ti Pizzeles <br />— Nut Mixes/Nut <br />--- Butters <br />Trail Mix/ Dried Fruit <br />Salteo <br />Caramel/Fudge <br />Popcorn. <br />Popcorn Balls <br />Vinegar <br />Fruit Butter" <br />Ground <br />Efl Chocolate <br />Jams/Jellies'• <br />Fried or Baked <br />Donuts and <br />Waffles <br />ci Dried Fruit <br />Marshmallows <br />Marshmalloyy <br />Bars' <br />Baked Goods Dried Pasta J Honey <br />U-leo or Dehyorateo Dried Vegetarian- j Vegetaoles Based Soup Mixes <br />r azeiton Avenue Stockton, Caltfornla <br />71 Vegetable and Potato Chios