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(dew- neem p(L <br />SAN�IOAQUIN Environmental Health Department COUNTY -Greatness grows here. <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 />A/1e t7 -e -!o d1cylFes )roma,ate✓J�Mz, C <br />CFO Physical Address: CFO City: CFO Zip: <br />Z 6? -q kloo9l0+1 t: f <br />Website (If applicable): Telephone: <br />+<.09(3 -Z33 9 <br />1. Categories: <br />21 "Class A' (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: J3 <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br />that are defined as "non -potentially hazardous' are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food -borne illness. <br />3. "Class A" Self Certification Checklist: e t came+a n Os 5 rr� 1 <br />❑ Checklist completed ("Class A" CFOs Only) O Den <br />4. <br />Products: <br />Please check the items <br />you will be preparing and/or selling. <br />F-1 <br />BakedGoods <br />El <br />Dried Pasta <br />El <br />Honey <br />E] <br />Popcorn <br />Popcorn Balls <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />ElFrosting/Icing' <br />Buttercream <br />ElFondant/Gumpaste` <br />Buttercream <br />❑ <br />Flat Icing <br />ElChocolate <br />Ground <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies'" <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />ElButters <br />Nut Mixes/Nut <br />❑ <br />Fried or Baked <br />Donuts and <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />E]Candied <br />Apples <br />E]Caramel/Fudge <br />E] <br />Marshmallow <br />Bars <br />1868 E. Hazelton Avenue I <br />Stockton, California 95205 1 <br />T 209 <br />468-3420 1 F 209464-0138 <br />1 www.sjgov.org/ehd <br />