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SAN JOAQUIN COUNTY fA P � <br /> ENVIRONMENTAL_ HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 n <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www_sipov.org/EHD ICS <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Ime: � rOwner Name: SW ate: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1-13�A"4_�;: �S j m r"a ro 1 U�htj4jD rte- �sL <br /> Website(if applicable): Telephone: <br /> - 209 b10 7q0 9 --- <br /> 1. Categories: <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 /> Ef Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> dBaked 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 ❑ ButtercreamEl Flat Icing El Chocolate Frosting/Icing Fondant/Gumpaste Chocolate <br /> ❑ Dried Mote Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars' <br /> EMD 18-27 8/29/2023 1 CFO REG/PERMITTING FORM <br />