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-,.,,1111;.: <br />;: <br />"''"; 5��;�QaQQ�N Environmental Health Department <br />—COUNTY— <br />ii, d^` Greatness grows here. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Dale: <br />"8 F:i4tr W ci%.,, t, -w t*r.o LLC- LtAVILA 'D t 4c w. uo 12 I r 3 IV <br />CFO Physical Address: CFO City; CFO Zlp: <br />15)q IWS D -a- L.p101 GtA gS2•!2 <br />Webslte (If appllcable): Telephone; <br />CI -2-S' 321 0-15 '9 <br />1. Categories: <br />A "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: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non-potentlally 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-bome illness. <br />3. "Class A" Self Certification Checklist: <br />X Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />y <br />Baked Goods <br />❑ <br />Candy <br />❑ <br />Churros <br />Buttercream <br />Frosting/Icing" <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />❑ Dried Pasta <br />❑ Dry Baking Mixes <br />❑ Waffle Cones <br />Buttercream <br />Fondant/Gumpaste" <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 />El <br />El <br />Popcorn <br />Popcom Balls <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />�( <br />Flat Icing <br />❑ <br />Ground <br />Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />Nut Mixes/Nut <br />Fried or Baked <br />❑ <br />❑ <br />Donuts and <br />Butters <br />Waffles <br />❑ <br />Trall Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />14 <br />Salted <br />❑ <br />Marshmallows/ <br />hmallow <br />Caramel/Fudge <br />B r <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 />