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P �ti <br /> SAN JOAQUIN Environmental Health Department <br /> _�_ —COUNTY— <br /> COTTAGE <br /> COUNT Y <br /> ��C1FOR��P ' t�(�OtI1c5� J7-i;,bk� ;1�Ic. r"I�,1 <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM '�� 16 D <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTOq R2IyF,�q���19 <br /> TiSER�'CFccc+++�TN <br /> CFO Business Name: Ow er Name:• Date: �� <br /> t� I 7 sq <br /> CFO Physical Address: CFO City: CFO Zip: <br /> "q U)• 4- , S-E a_,1 cTo,o C.-�L Ci S.Z o 7 <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $146 "Class B" (Direct& Indirect Sales) $292 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: Yee <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 ❑ Popcorn/ <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* El Flat Icing ❑ 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 /> ❑ 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 209464-0138 1 www.sjcehd.com <br />