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SAN JOAQUIN <br />CGUN-v <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />NUt1cy DC& AYICC- ons c41.1m VI/illiA#jS IZ I -2f <br />CFO Physical Address: CFO Ci y: CFO Zip: <br />5(4 01'r Dr. R-1royl 15966 <br />Website (If applicable): Telephone: <br />/ (Zdi) 9 o l — Loo3 <br />1. Cate-gories: <br />K "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: M Vy <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 />g Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />JZ <br />Baked Goods <br />❑ <br />Dried Pasta <br />El <br />Honey <br />El <br />Popcorn <br />Popcorn Balls <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />❑ <br />Buttercream" <br />ElButtercream <br />El <br />Flat Icing <br />❑ <br />Ground <br />Frosting/Icing <br />Fondant/Gumpaste" <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies"" <br />F1Fruit <br />Empanadas <br />❑ <br />Fruit Tamales/Pies <br />ElButters <br />Nut Mixes/Nut <br />El <br />Fried or Baked <br />Donuts and <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted <br />Marshmallows/ <br />❑ <br />Cotton Candy <br />❑ <br />Candied Apples <br />❑ <br />Caramel/Fudge <br />❑ <br />Marshmallow <br />Bars" <br />❑ <br />Dried or Dehydrated <br />El <br />Dried <br />Dried Vegetarian- <br />❑ <br />Vegetable and Potato <br />Chips <br />Vegetables <br />Soup Mixes <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 />