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SAN.JOAQUIN Environmental Healt partment <br /> _.._..COUNTY <br /> Greatness grows here. <br /> ENV Maos � <br /> COTTAGE FOOD OPERATIONS (CFO) p RMS P, ?419 <br /> REGISTRATION/PERMITTING FORM SFR �s<ry <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> nes N?tme: Date: <br /> V�aW Uh(A \, DUtY) 66 1 D I 1 I I <br /> CFO Ph sical Address: CFO City: CFO Zip: <br /> I�tiK 4\Mtty, 6t. IW&I oti., 53Z� <br /> Website(If applicable): Telephoe; <br /> �oa �� uus� l <br /> 1. Categories. <br /> "Class A" (Direct Sales Only) $155 lass B" (Direct& Indirect Sales) $310 <br /> 2. Prohibited Items: Initial if you agree to abide by the followinc�;_� <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 ❑ Flat Icing ❑ 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 ❑ ❑ Marshmallow <br /> Caramel/Fudge 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 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />