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SAN JOAQUIN <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 />V\ �\ �\ P � ti L�Lc2 �3—\-,aa <br />CFO Physical Address: CFO City: CFO Zip: <br />Website (If applicable): <br />1. Categories: <br />"Class A" (Direct Sales Only) $155 <br />❑ "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 />Buttercream <br />❑Buttercream <br />Checklist completed ("Class A" CFOs Only) <br />Icing <br />❑ <br />Ground <br />4. Products: <br />Frosting/Icing* <br />Fondant/Gumpaste* <br />Please check the items you will he preparing and/or selling. <br />Baked Goods El Dried Pasta <br />El Honey <br />El <br />Popcorn <br />Popcorn Balls <br />❑ Candy ❑ Dry Baking Mixes <br />❑ Mustard <br />❑ <br />Vinegar <br />❑ Churros ❑ Waffle Cones <br />❑ Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />❑ <br />Buttercream <br />❑Buttercream <br />ElFlat <br />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 />Nut Mixes/Nut <br />Fried or Baked <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Butters <br />❑ <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 />r-1Cotton <br />Candy <br />LlCandied <br />Apples <br />ElCaramel/Fudge <br />El <br />Marshmallow <br />Bars* <br />❑ <br />Dried or Dehydrated <br />❑ <br />Dried Vegetarian- <br />❑ <br />Vegetable and Potato <br />Chips <br />Vegetables <br />Based 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 />