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SAK OAQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />CFO Business Name: <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Owner Name: <br />Date: <br />CFO Physical Address: 0 CFO City: _0 CFO Zip: <br />10l We -s+ V'ta-.r— 5Mee'\- 1-od< C 95140 <br />Website (If applicable): Telephone; <br />r, <br />rNql 4f.1 <br />1. Categories: <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: iZ'MF <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 />D9 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 />❑ <br />Candy <br />❑ <br />Churros <br />❑ <br />Buttercream <br />Frosting/Icing* <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />�U Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />ofl <br />Dry Baking Mixes <br />❑ <br />Waffle Cones <br />❑ <br />Buttercream <br />Fondant/Gumpaste* <br />❑ <br />Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Dried or Dehydrated ❑ Dried Vegetarian - <br />Vegetables Based Soup Mixes <br />❑ Honey ❑ Popcorn/ <br />Popcorn Balls <br />❑ Mustard ❑ Vinegar <br />® Dried Grain Mixes ❑ Fruit Butter** <br />�C] <br />Flat Icing <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />Fried or Baked <br />❑ <br />Nut Mixes/Nut <br />El <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />ElCaramel/Fudge <br />SaltedMarshmallows/ <br />[It <br />Marshmallow <br />Bars* <br />❑ 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 />