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SAN JOAQUIN <br />—COUNTY— <br />u eq oi% �,.FowC hclt'. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CBusiness N me: �j"' <br />C4 II <br />CFO P ical Address: <br />Name: <br />Website (If applicable): TelephoS lb 1, 4- <br />1. <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 <br />Date: <br />CFO <br />❑ "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: <br />.?L <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br />that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food -borne illness. <br />3. "Class A" Self Certification Checklist: <br />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 />❑ Fruit Empanadas <br />Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />ElButtercream <br />Fondant/Gumpaste* <br />XHerb/Spice Blends <br />❑ Fruit Tamales/Pies <br />L Seasoning Salt <br />❑ Candied Apples <br />❑ Honey <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Pizzeles <br />El Butters Mixes/Nut <br />Butters <br />Churros <br />Buttercream <br />❑ <br />Frosting/Icing* <br />❑ <br />Dried Mole Paste <br />❑ Fruit Empanadas <br />Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />ElButtercream <br />Fondant/Gumpaste* <br />XHerb/Spice Blends <br />❑ Fruit Tamales/Pies <br />L Seasoning Salt <br />❑ Candied Apples <br />❑ Honey <br />❑ Mustard <br />❑ Dried Grain Mixes <br />❑ Flat Icing <br />❑ Pizzeles <br />El Butters Mixes/Nut <br />Butters <br />❑ Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />Salted Marshmallows/ <br />Caramel/Fudge ❑ Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Vinegar <br />Fruit Butter** Alt) <br />El <br />Chocolate Chocolate <br />❑ Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br />Salted Marshmallows/ <br />Caramel/Fudge ❑ Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br />