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a�4��^''•� SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 •�� %+Opti'`�• Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.s'cehd.com COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: Owner Name: Date: TNS KdEKSIS`T��GO Sune,�le � tP�e�nale�r'�P,r' �1281 23 CFO Physical Address: CFO City: CFO Zip: N(ATC"INS STAT 1,0 C)I , (-A� x6240 Website(If applicable): ^GGephoneoo G^Cd 1. Categories: [/ "Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct& Indirect Sales)$486 2. Prohibited Items: Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as"non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness. 3. "Class A" Self Certification Checklist: Dq Checklist completed ("Class A"CFOs Only) 4. Products: Please check the items you will be preparing and/or selling. ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ Popcorn Balls ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** Buttercream Buttercream Ground ❑ Frosting/Icing* ❑ Fonda nt/G um paste* ❑ Flat Icing ❑ Chocolate ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut Fried or Baked ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ® Donuts and Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow Bars EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM