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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) C <br /> CFO Business Name: Owner Name: Date: v' <br /> 2016AKE(z`( Uo*s 1- I-u -zczl <br /> CFO Physical Address: CFO City: CFO Zip: <br /> Gist' w• LotJtxJ1EW PJB <br /> Website(If applicable): Telephone: <br /> x li vnas �c>�ma� �, wm aoa- g69 ss- <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: ✓'1t7-� <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 /> Y% 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* � Flat Icing Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> I�ri <br /> ❑ Fruit Empanadas El Fruit Tamales/Pies Ia Nut Mixes/Nut Fried or BakedButters Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt Trail Mix/Dried Fruit Dried Fruit <br /> �¢ Salted Marshmallows/ <br /> El Cotton Candy V Candied Apples )�' Caramel/Fudge Marshmallow <br /> Bars' <br /> Dried or Dehydrated Dried Vegetarian- <br /> ❑ Vegetables E] Dried <br /> Soup Mixes El Vegetable and Potato Chips <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />