Laserfiche WebLink
Date: <br />5/D 5^? & <br />□"Class A” (Direct Sales Only) $186 “Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />3. <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□□HoneyBaked Goods <br />□□ VinegarMustardCandy <br />□□Dried Grain MixesWaffle ConesChurros <br />□□□Flat Icing <br />□□ Jams/Jellies**□□PizzelesHerb/Spice Blends <br />□□Fruit Tamales/PiesFruit Empanadas <br />□0 Dried Fruit□ Seasoning Salt□Trail Mix/ Dried FruitGranola/Cereals <br />□0 Candied Apples□Cotton Candy <br />i CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />Buttercream <br />Frosting/lcing* <br />Dried Mole Paste <br />Buttercream <br />Fondant/Gumpaste* <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Popcorn/ <br />Popcorn Balls <br />Ground <br />Chocolate <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/EHD <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />0 Dried Pasta <br />[p/Dry Baking Mixes <br />0 <br />_ CFO Zip: <br />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 />“Ctass A” Self Certification Checklist: <br />[M Checklist completed (“Class A” CFOs Only) <br />0 Fruit Butter** <br />CFO Business Name: . . * Owner Name: <br />CFO Physical Address: J j CFO City: <br />lb fy flrfcru) W- <br />Website (If applicable): . ' Telephone: <br />1. C^t€qories: <br />FT"’-