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SAN 10AQ U I N Environmental Health Department <br /> � COUNTY <br /> Greatness grows nem. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Bu si ess Name: Owner Name: Date: <br /> l�resl� I Y1i )r1 W t o f <br /> CFO Physical Address: CFO City: CFO Zip: <br /> q 51 (tea c 15-3- <br /> Website(Ifap licable): Telephone: <br /> vel. w 2 es I . v 13C <br /> ho4- re add' e+� <br /> 1. Categories: <br /> X "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 /> X Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> XBaked 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 * ElButtercream * El 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 ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars* <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables 1:1 Dried <br /> Soup Mixes F1 Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209468-34201 F 209464-0138 1 www.sjcehd.com <br />