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SANAAQUIN <br /> Environmental Health Departmen <br />t <br />Gref24, <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Date <br /> <br />insgs Name Orergr Name csaiovi ina .1-A*01,ot (i• <br /> <br />CFO Physical dress CFO cdy trail V1 1-10cice CFO Zip <br />S3 <br />CFO 8 <br />Websde (If applicable) Telephone <br />31 - <br />1. Categories: <br />-11 "Class A" (Direct Sales Only) $155 D "Class B" (Direct & Indirect Sales) $310 <br />Prohibited Items: Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br />Only <br />foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />A Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/lcing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />Dried or Dehydrated <br />Vegetables <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />0 Fruit Tamales/Pies <br />0 Seasoning Salt <br />0 Candied Apples <br />0 Dried Vegetarian- <br />Based Soup Mixes <br />1868 E. Hazelton Avenue j Stockton, California 95205 T 209 465-3420 F 209 454-0138 www.$)gov otglE.HD <br />1*1 Honey <br />El Mustard <br />Li Dried Grain Mixes <br />Li Flat Icing <br />Li Pizzeles <br />ivn Nut Mixes/Nut <br />Butters <br />Tv\ Popcorn/ <br />le Popcorn Balls <br />Li Vinegar <br />Li Fruit Butter— <br />Ground <br />Li Chocolate <br />Li Jams/Jellies** <br />Fried or Baked <br />Li Donuts and <br />Waffles <br />ID Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />NI Marshmallow <br />Bars* <br />Li Vegetable and Potato Chips <br />Li Salted <br />Caramel/Fudge <br />rwod- (Nee6(2._e <br />"P R o 4fl-83 <br />°V\ 0‘\,o0v-V cO'N-tro cAfyin