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SAN ;,J000UIN Environmental Health Department <br />—Cour <br />Cls y/. <br />iVdrr ad are lEn(-� 00e CFD, tVe GiP l e vers. <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Ov er Name: Date: <br />'rs�v �a.1✓ N'I;)A IiAU1R0 Sanl /7 ,Z- 5 <br />CFO Physical Atldress: A. -hb^ N,/a( Awacc y CFO Zip: <br />ri riz UJ44 /.,n, IA ZF15�4/C <br />Website (If applicable): Teiephare: <br />goy 1/5a 5759 <br />1. Cateaories: <br />"Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 <br />VA Ren ewe/ <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 ALL WED. Onlyfoods <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-bome illness. <br />3. "Class A" Self Certification Checklist: <br />IX Checklist completed ("Class A' CFOs Only) <br />4. <br />Products: <br />Please check the items you will be preparing and/or selling. <br />❑ <br />Baked Goods <br />❑ <br />Dried Pasta <br />❑ <br />Honey <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churms <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />❑ <br />Buttercream <br />❑ <br />Buttercream <br />❑ <br />Flat Icing <br />❑ <br />Ground <br />Frosting/Icing" <br />FondanVGumpaste' <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />Mixes/Nut <br />Fried or BakedButters <br />❑ <br />Fruit Empanadas <br />E]Fruit <br />Tamales/Pies <br />ElNut <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 />E]Cotton <br />Candy <br />E]Candied <br />Apples <br />ElCaramel/Fudge <br />❑ <br />Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br />