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' SAN JOAQUIN COUNTY <br /> . SA� �yp 13,0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> :' Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orgfEHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> 1 <br /> bVAA-K-G( FA�S Mar_rrie ILLS Izo2 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> �2_30 5 330 <br /> Website(If applicable): Telephone: <br /> �-�1r2-I5(ol <br /> 1. to ories: <br /> "Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $486 <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. <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 /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> [V' Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream Ej/Buttercream [R"'Flat Icing ❑ Ground <br /> Frosting/Icing Fonda nt/Gum paste* Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Fmpanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> p,�Salted Marshmallows/ <br /> ❑ Cotton Candy El Candied Apples Caramel/Fudge ❑ Marshmallow <br /> Bars' <br /> EHD 16-27 6/2912023 1 CFO REGIPERMITTING FORM <br /> S <br />