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S A N J OA Q U I N Environmental Health Department —COUNTY Greotness qrows here. COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: Owner Name D1 4/18/2022 The Cookielyfe Dezare Casas CFO Physical Address: CFO City: CFO Zip. 2274 Momingside Ct Tracy 95376 Website (If applicable): Telephone: 209-814-3347 1. Categories: ® "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 2. Prohibited Items: Initial if you agree to abide by the following: AC Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-bome illness. 3. "Class A" Self Certification Checklist: x❑ Checklist completed ("Class A" CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. ❑x Baked Goods ❑ Candy ❑ Churros L1Buttercream Buttercream Frosting/Icing' ❑ Dried Mole Paste ❑ Fruit Empanadas ❑ Granola/Cereals ❑ Cotton Candy ❑ Dried Pasta ❑ Dry Baking Mixes ❑ Waffle Cones ❑ Buttercream Fondant/Gumpaste' ❑ Herb/Spice Blends ❑ FruitTamales/Pies ❑ Seasoning Salt ❑ Candied Apples ❑ Dried or Dehydrated E] Dried Vegetarian - Vegetables Based Soup Mixes Ll Honey ❑ Popcom/ Popcorn Balls ❑ Mustard ❑ Vinegar ❑ Dried Grain Mixes ❑ Fruit Butter" El Flat Icing El Chocolate Chocolate ❑ Pizzeles ❑ Jams/Jellies" Nut Mixes/Nut Fried or Baked ❑ Butters El Donuts and Waffles ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Marshmallows/ ❑ Salted ❑ Marshmallow CarameVFudge Bars' ❑ Vegetable and Potato Chips 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD