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SAN J OAQ U I N Environmental Health Department <br />COUNTY— <br />„",_,, 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: Da <br />LA Luna coif<o . TGrct Plrn � lytza <br />CFO Physical Address: ""t <br />CFO Zi <br />I� Tnwuad flare Mane CE30 <br />Website (If applicable): Telephone: <br />2j6,f �/�aq-z?6 <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 <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 AL WED. 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 />Popcorn/ <br />❑ <br />Please check the items you will be preparing and/or <br />selling. <br />Baked Goods <br />❑ Dried Pasta <br />Honey <br />` �l Candy <br />❑ Dry Baking Mixes <br />❑ Mustard <br />❑\ Churros <br />❑ Waffle Cones <br />❑ Dried Grain Mixes <br />Buttercream <br />Frosting/Icing* <br />❑ Dried Mole Paste <br />❑ Fruit Empanadas <br />❑ Granola/Cereals <br />❑ Cotton Candy <br />ElButtercream <br />Fondant/Gumpaste* <br />❑ Herb/Spice Blends <br />❑ Fruit Tamales/Pies <br />❑ Seasoning Salt <br />❑ Candied Apples <br />❑ Flat Icing <br />❑ <br />Popcorn/ <br />❑ <br />Popcorn Balls <br />❑ <br />Vinegar <br />❑ <br />Fruit Butter** <br />El <br />❑ <br />Chocolate Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies** <br />Nut Mixes/NutFried <br />or Baked <br />ElButters <br />❑ <br />Donuts and <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Salted �{ Marshmallows/ <br />El Caramel/Fudge Ja 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.org/ehd <br />