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=' gz SA NA M U I N Environmental Health Department <br /> a 1 <br /> —COUNTY— <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Ownpr Name: Date: <br /> �Ara�t�Z AcZati Atn�T�1 —I •�.1 • �a <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Ln -viii 41�nosk*y%_az> *I's -310 0\cTQ%" qyW+ <br /> Website If applicable): Telephone: <br /> Wall-F�o� �.tnfoC� �,mat(. corn ICA-4,au-S--T <br /> 1. Categories: <br /> ❑ "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 /> ❑ Checklist completed("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> �J Baked Goods El Dried Pasta E] Honey El Popcorn Ppcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ Buttercream ❑ Buttercream 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 E] Dried Vegetarian- <br /> Vegetables Based Soup Mixes ❑ Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />