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SAN J O A Q U I N Environmental Health Department <br />COUNTY— <br />_.rotnres grows here <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: SAN D N 7A Date: <br />IZ- I lb 12o2-1 <br />CFO Physical Address: CFO City: CFO Zip: <br />46$ W C -n?, II'MOUrJ-rA!_^I HOUSE 153,11 <br />Website (If applicable): Telephone: <br />www. bop�%ooAuw •Corn <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 I <br />Foods containing cream, custard, or meat fillings are potentially hazer <br />foods that are defined as "non -potentially hazardous" are approved for pre <br />These foods include items that do not require refrigeration to keep them sal <br />cause of food -borne illness. <br />3. "Class A" Self Certification Checklist: <br />Q Checklist completed ("Class A° CFOs Only) <br />4. Products: <br />Please check the Items you will be preparing and/or selling. <br />❑ Baked Goods <br />❑ Candy <br />❑ Churros <br />❑ Buttercrearn <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Colton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />❑ <br />Buttercrcatii <br />Fondant(Gumpaste* <br />❑ Herb/spice ,;lends <br />U rruft Tamales/Pies <br />0 seasoning Salt <br />Ej Candied Apples <br />Dried or Dehydratad Dried Vegetarian <br />F1 Vugetables I 3ased Soup Mixes <br />❑ <br />Honey <br />❑ <br />Mustard <br />❑ <br />Dried Grain <br />❑ <br />Flat Icing <br />❑ <br />Pi7Ze18S <br />❑ Nut Mir <br />Br fitters <br />the following: S <br />lus and are NOT ALLOWED. Only <br />ration by a Cottage Food Operation. <br />from bacterial growth that could be a <br />El Popcorn/ <br />Popcom Balis <br />❑ Vinegar <br />❑ Fruit Butter** <br />El <br />Fruit <br />❑ Dried Fruit <br />Chocolate Chocolate <br />❑ <br />JamS/Jellies** <br />❑ Marshmallow <br />Fried or Baked <br />0 <br />Donuts and <br />Waffles <br />❑ Trail Mix/ Dried <br />Fruit <br />❑ Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />❑ Marshmallow <br />Caramel/Fudge <br />Bars* <br />F1 Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />