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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:www�gov.orglEHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTiNG FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> F%\te- Loc�,ves , o.;-ao h Je_SS%6C1 MQC14S 02 r_(a /2 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> %-7 3Q Cc-`n kc C \,i 1 G-ko c k�v) Z o4- <br /> Website(If applicable): Telephone: <br /> - 40 y5--7G-ZZ <br /> 1. Categories: <br /> Z "Class A"(Direct Sales Only) $186 ❑ "Class B" (Direct R Indirect Sales)$486 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: j M - <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 /> E�/Checkiist completed("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Baked Goods ElDri Popcorn/ed Pasta ❑ Honey ❑ Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter`* <br /> ❑ Buttercream ❑ Buttercream k ❑ Flat Icing El Ground <br /> Frosting/Icing* Fondant/Gumpaste Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ . Butters ❑ 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 6/2912023 CFO REGIPERMITTING FORM <br />