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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name r PRVJ rett9 <br />CFO Physical Address: CFO City: <br />.)\.1 ut..tie.)-- —7 12 <br /> <br />Date: (3 / /0.e.,3 <br />CFO Zip: <br /> <br />1 2 C"-HELe r Lei r\cl' pri -e <br />Website (If applicable): Telephone: <br />(20m) - 15 <br />Categories: <br />-Class A" (Direct Sales Only) $186 E] "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 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 />"Class A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />LI <br />fl <br />LI <br />LI <br />LI <br />LI <br />El <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />G ranola/Cereals <br />Cotton Candy <br />E] <br />El <br />LI <br />LI <br />LI <br />LI <br />El <br />El <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 />0 <br />El <br />El <br />CI <br />LI <br />0 <br />1:1 <br />LI <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />LI Fruit Butter** <br />Ground LI Chocolate <br />LI Jams/Jellies — <br />Fried or Baked <br />LI Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />LI Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd