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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 />El Vinegar <br />Fruit Butter** <br />III Ground <br />Chocolate <br />0 Jams/Jellies" <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />Vegetable and Potato Chips <br />SAN ,JOAQUIN <br /> Environmental Health Department <br />—COUNTY <br />Greatness grows hrc <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />ba-keLt & 6. .)\1 ty[CLWN \A-Ydoa c N. <br />CFO Physical Address: CFO City: <br />Ug D W. Toutc-k-vv SA. <br />Website (If applicable): Telephone: <br />,Actcrukr\ <br /> <br />Date: , <br />lli ool3 <br />CFO Zip: <br />4k U <br /> <br />6)) oc0 -11-AD -,2 - <br />Categories: <br />yj "Class A" (Direct Sales Only) $155 0 "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-potentially 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-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 />)KI <br />111 <br />D <br />0 <br />0 <br />El <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />Dried or Dehydrated <br />Vegetables <br />0 <br />0 <br />0 <br />0 <br />D <br />0 <br />Li <br />n <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 Vegetarian- <br />Based Soup Mixes <br />0 <br />0 <br />0 <br />0 <br />LI <br />El <br />0 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />p 5118372_ <br />Scanned with CamScanner