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Home My WebLink Aboutcfo-registration-form-ada Ronald Browder Director 1131 Harbor Bay Parkway, Alameda, CA 94502 | Health.AlamedaCountyCA.gov/ACEHD | (510) 567-6700 CALIFORNIA HOMEMADE FOOD ACT AB1616 (GATTO) REGISTRATION / PERMITTING FORM CFO Business Name: Date: CFO Physical Address: CFO City: CFO Zip: Owner Name: Owner Phone: Owner Cell: Mailing Address (If different): Mailing City: Mailing Zip: Email Address: Website/Social Media/Advertising: 1.Categories: ☐“ Class A” (Direct Sales Only)☐ “Class B” (Direct & Indirect Sales) 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 (CFO). These are food 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: Complete approved food list: https://www.cdph.ca.gov/Programs/CEH/DFDCS/CDPH%20Document%20Library/FDB/FoodSafe tyProgram/CottageFood/ApprovedCottageFoodsList.pdf Ronald Browder Director 1131 Harbor Bay Parkway, Alameda, CA 94502 | Health.AlamedaCountyCA.gov/ACEHD | (510) 567-6700 Page 2 of 5 Please check ALL of the items you will be preparing and/or selling. ☐Baked Goods ☐Dried Pasta ☐Honey ☐Popcorn ☐Candy ☐Dry Baking Mixes ☐Mustard ☐Vinegar ☐Churros ☐Waffle Cones ☐Tortillas ☐Fruit Butter ** ☐Dried Mole Paste ☐ Herb/Spice Blends ☐Pizelles ☐Jams/Jellies** ☐Trail Mix ☐Fruit Tamales/Pies ☐Nuts/Nut Mixes ☐ Dried Fruit ☐Fruit Empanadas ☐ Nut Butters ☐Dried Tea ☐Roasted Coffee ☐Granola/Cereals ☐ Sweet Sorghum Syrup ☐ Chocolate Covered Nonperishable Food ☐Other: ** These items must comply with standards described in Part 150 of Title 21 of the Code of Federal Regulations http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 Food Descriptions: 5.Product Labeling:Initial if you agree to abide by the following: _______ For a detailed description, see the CDPH document “Labeling Requirements for Cottage Food Products.” All cottage food products must be properly labeled in compliance with the Federal, Food, Drug, and Cosmetic Act (21 U.S.C. Sec. 343 et seq.) The label must include: •The words “Made in a Home Kitchen” in 12-point font •The name commonly used to describe the food product •The name city, state and zip code of the cottage food operation which produced the cottage food product. If the firm is not listed in the current telephone directory then a street address must also be declared. (A contact phone number or email address is optional but may be helpful for consumers to contact your business.) •The registration or permit number of the cottage food operation which produced the cottage food product and in the case of “Class B” CFOs, the name of the county where the permit was issued. Ronald Browder Director 1131 Harbor Bay Parkway, Alameda, CA 94502 | Health.AlamedaCountyCA.gov/ACEHD | (510) 567-6700 Page 3 of 5 • The ingredients of the food product, in descending order of predominance by weight, if the product contains two or more ingredients. • The net quantity (count, weight or volume) of the food product. It must be stated in both English (pound) units and metric units (grams). • A declaration on the label in plain language if the food contains any of the nine major food allergens such as milk, eggs, fish, shellfish, tree nuts, wheat, peanuts, soybeans and sesame. There are two approved methods prescribed by federal law for declaring the food sources of allergens in packaged foods: 1) in a separate summary statement immediately following or adjacent to the ingredients list, or 2) within the ingredients list. • Labels must be legible and in English (accurately translated information in another language may accompany it). • Labels, wrappers, inks, adhesives, paper, and packaging materials that come into contact with the cottage food product by touching the product or penetrating the packaging must be food-grade (safe for food contact) and not contaminate the food. Example: Note: For the “Issued in County” – Identify the jurisdiction (city/county) where you are obtaining approval. Ronald Browder Director 1131 Harbor Bay Parkway, Alameda, CA 94502 | Health.AlamedaCountyCA.gov/ACEHD | (510) 567-6700 Page 4 of 5 6.Water Source: Please identify the water source to be used in Cottage Food Facility (Check one box) ☐Name of Public Water System or Community Services District: ☐If you use a Private Water Supply**, identify the source (well, spring, surface, etc.): Private Water Supply: Initial Water Quality Results Check boxes below if initial water testing has been completed. All testing must be done at a State Certified Laboratory. Then either attach lab results or provide name of lab, date & results in space provided next to type of test. *(Testing Frequencies for Transient Non-Community Water Systems after initial testing) ☐Bacteriological Test (quarterly*): ☐Nitrate Test (yearly*): ☐Nitrite (every 3 years*): ** Additional information may be required if food is prepared from a home with a private water supply – Check with local jurisdiction 7.Disposal of Waste: Please check what type of treatment is used to dispose of waste ☐Public Sewer Service ☐Private Septic System *In the event of septic system failure or plumbing problem, you are required to notify Alameda County Environmental Health Department immediately. 8.Food Processor Course: Initial if you agree to abide by the following: _______ Within 3 months of being approved to operate by the Environmental Protection Division, please provide proof of completion of the required California Department of Public Health (CDPH) food processor course*. Proof of completion may be emailed directly to your District Inspector.* See CDPH Website for more information: Cottage Food Operator Training 9.Employee: Initial if you agree to abide by the following: _______ I understand that I may not have more than one full-time equivalent cottage food employee, not including a family member or household member of the cottage food operator, working within the registered or permitted area of a private home where the cottage food operator resides and where cottage food products are prepared or packaged for direct, indirect, or direct and indirect sale to consumers. Ronald Browder Director 1131 Harbor Bay Parkway, Alameda, CA 94502 | Health.AlamedaCountyCA.gov/ACEHD | (510) 567-6700 Page 5 of 5 10. Gross Annual Sales: Initial if you agree to abide by the following: _______ I understand that I will lose my CFO status and will need to become permitted in a commercial facility if my CFO business exceeds the following gross annual sales figures for the calendar year in the following table: CFO Class Gross Annual Sales Class A $75,000* Class B $150,000* *The annual average adjustment rate is based on previous years Consumer Price Index. Refer to California Department of Public Health’s website at https://www.cdph.ca.gov/Programs/CEH/DFDCS/Pages/FDBPrograms/FoodSafetyProgram/Cotta geFoodOperations.aspx for the current gross annual sales limit. 11.Delivery Limitations:Initial if you agree to abide by the following: _______ I understand that I may accept orders and payments via the phone, internet or any other digital method. A direct sale may be fulfilled in person or using any other third-party delivery service, such as United States Postal Service, UPS, or FedEx. 12.Owner’s Statement: I, _________________________ agree to grant access to the local health department to conduct an inspection of my cottage food operation (mark one): ☐ “Class A” In the event of a consumer complaint or reported food-borne illness ☐ “Class B” For regular annual facility inspections and in the event of a consumer complaint or food-borne illness I, ________________________, agree to notify Alameda County Environmental Health Department prior to modifying my food list, type of operation, and/or method of selling, distributing, or otherwise providing my CFO products to the consumer or retailers, regardless of whether the product is sold, consigned, or given away. __________________________________ _____________________________ ________________ Owner’s Signature Print Name Date DATE APPROVED: EHS: OFFICE USE ONLY AMT RECEIVED DATE RECEIVED DATE OF PAYMENT PAYMENT TYPE: CASH CHECK CREDIT/DEBIT CHECK# DATE OF CHECK INVOICE # OW# FA# PR#