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SAN JOAQUIN COUNTY <br /> r ' --Nl <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> }. �a Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si4ov.org/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 /> P-TS'o jDe51C 3` ��- Z <br /> CFO Phvsical Address: CFO City: CFO Zip: <br /> vt i LoAL Q52yu <br /> Website(If applicable): J Telephone: <br /> Z; '(Z �1 "' n, <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $186 ❑ "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 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 /> 3. "Class A" Self Certification Checklist: <br /> 2'Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> F-1Baked Goods F-1Dried Pasta ElHoney ElPopcorn/Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard "Winegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes b Fruit Butter" <br /> ElButtercream ElButtercream ❑ Flat Icing ❑ Ground <br /> Frosting/Icing` Fondant/Gumpaste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles Jams/Jellies** <br /> Nut Mixes/NutFried or Baked <br /> ❑ Fruit Empanadas E] Fruit Tamales/Pies Butters E] Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt Trail Mix/Dried Fruit Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br /> �e(%AD <br /> kvk <br /> .4-1 <br />