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SANJOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness <br /> OUNTY— <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> �F�B� l(CALIFORNIA HOMEMADD�E� FOOD ACT AB 1616 (GATTO)) <br /> sinF "aet�l �lllinh �lA Name: JR(1*tDDate: <br /> SIV1.ILT <br /> -112-J'1 0 --D <br /> CFO Physical Address: C O city: CFO Zip: <br /> 2 L1 <br /> 2-2 B1LAfA&1 �X>o.V I,-� A CK 115240 <br /> Website(If applicable): Telephone:q25-117_ Q.1 -cg <br /> 1��1.. ///Categories: <br /> pX -Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales)$310 <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. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ] Baked Goods ❑ Dried Pasta ❑ Honey j Popcom/ <br /> / e <br /> Popcorn Balls <br /> Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** <br /> Buttercream Buttercream Ground <br /> Frosting/Icing* Fondant/Gumpaste* Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> El Fruit Empanadas ❑ Fruit Tamales/Pies Elgutters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> / Salted Marshmallows/ <br /> /y( Cotton Candy ] Candied Apples Caramel/Fudge Marshmallow <br /> Bars <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />