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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> f 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orglEHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Dame: Owner N e. Date: <br /> CFO Physics Address: CFO City: CFO Zip: <br /> 3416 Cora1 2y� a�vebzm Cl <br /> Website(If applicable): Telephone: <br /> 1. Categories: <br /> [r "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. RECEIVED <br /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class A" CFOs Only) DEC 0 8 M <br /> L-NN'llRON NILNTAL HEALTH <br /> 4. Products: 1)I-.flit RFNlENT <br /> Please check the items you will be preparing and/or selling. <br /> ['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 Buttercream Ground <br /> ❑ Frosting/icing" ❑ Fonda nt/Gumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit TamalesiPies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy El Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars" <br /> EHD 16-27 M90)23 1 CFO REGIPERMITTING FORM <br /> �2210 000 <br />