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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.ord/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />V ret L e- R/ST \ AT VcuJ <br />CFO Physical Address: CFO City: <br />kLkl 3 FA t\k,-10 2---D• <br />Date: <br />3 - - <br />CFO Zip: <br />Website (If applicable): <br />TelePil?ffe'-2Z)C) 3'•1 G -37 <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />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. <br />Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br />Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />111 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El <br />D <br />El <br />El <br />C1 <br />CI <br />LI <br />111 <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 />ID <br />111 <br />El <br />El <br />El <br />El <br />El <br />I=1 <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gurnpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />[11 <br />El <br />El <br />El <br />1:1 <br />El <br />I=1 <br />El 'I <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/ El Popcorn Balls <br />1:1 Vinegar <br />ID Fruit Butter** <br />Ground El Chocolate <br />El Jams/Jellies** <br />Fried or Baked <br />I=1 Donuts and <br />Waffles <br />I=1 Dried Fruit <br />Marshmallows/ <br />CI Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />