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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT • �/ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www sigov.OrQ/EHD COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO iness N e: l a Ow ame Da-te: In F lf & moy- - 1 CFO Physical Address CFO City: CFO Zip: , .v end -�y �I pain q� � Website(If applicable): Telephone: L b,5co- O r D D 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: ❑ 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* ElFondant/Gumpaste* El Flat icing ElChocolate ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeies Jams/Jellies** Nut Mixes/Nut Fried El Donuts d ra Baked ❑ ❑Fruit Fmpanadas ❑ Fruit Tamales/Pies Butters Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow Bars* EHD 16-27 6129/2023 1 CFO REGIPERMITTING FORM 2 S