Laserfiche WebLink
CFO Business Name: , Owner Name: <br />CFO Physical Address: CFO City: <br />3 mica., eou-Ch9tilisik3y) <br />C <br />Baked Goods <br />El Candy <br />LI Churros <br />El Buttercream <br />Frosting/Icing* <br />LI Dried Mole Paste <br />0 Fruit Empanadas <br />LI Granola/Cereals <br />LI Cotton Candy <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.siqov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Date <br />E (°- 2-1 <br />CFO Zip: <br />0 q,--)1-1 (orioin 1-00k1 9 PD <br />Website (If applicable): Telephone: <br />Ct • CAr2:iO - <br />Categories: <br />15( "Class A" (Direct Sales Only) $186 LI "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 A LOWED. <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 />9;,Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />LI <br />El <br />LI <br />1=1 <br />El <br />0 <br />LI <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />LI <br />LI <br />LI <br />a <br />LI <br />LI <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />LI Vinegar <br />[1111 Fruit Butter*" <br />Ground Li Chocolate <br />[-] Jams/Jellies" <br />Fried or Baked <br />Li Donuts and <br />Waffles <br />[1 Dried Fruit <br />Marshmallows/ <br />LI Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM