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RECEIVED <br /> SAN .10AHIN Environ.mental He <br /> JUL 05 2018 <br /> ENVIRONiNIENTAIL 111EALTI-1 <br /> COTTAGE FOOD OPERATIONS (CFO) DEP;kRTiNIENT <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> o,\� Z(-kcp <br /> Website(if applicable): Telephone: <br /> C( (<�Ck <br /> 1. Categories: <br /> \Q "Class A" (Direct Sales Only) $146 F-1 "Class B" (Direct& Indirect Sales) $292 <br /> r--L, <br /> 2. Prohibited Items: Initial if you agree to abide by the following: UVS� <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 <br /> be a cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> Checklist completed ("Class A" CFOs Only) <br /> 4. Products 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 F1 Mustard Ll Vinegar <br /> F-1 Churros F-1 Waffle Cones Fj Dried Grain Mixes E] Fruit Butter** <br /> Buttercrearn El Buttercrearn E] Flat Icing Ground <br /> Frosting/Icing Fondant/Gumpaste* Chocolate <br /> E] Dried Mole Paste Herb/Spice Blends F-1 Pizzeles E] Jams/Jellies** <br /> Nut Mixes/Nut Fried or Baked <br /> F-1 Fruit Empanadas E] Fruit Tamales/Pies Butters Donuts and <br /> Waffles <br /> Granola/Cereals El Seasoning Salt Trail Mix/ Dried Fruit E] Dried Fruit <br /> Salted Marshmallows/ <br /> F-1 Cotton Candy ❑ Candied Apples Caramel/Fudge ❑ Marshmallow <br /> Bars* <br />