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,rFeb-2018 12:41 From Abigail Albarillo. Phone #5105868868 FaxZero. p.2 <br /> f?� AMSAN JOAQUIN COUNTY �`�� 82 2018 <br /> ENVIRONMENTAL HEALTH DEPARTMENT f*Rot4ff, <br /> 1868 East Hazelton Avenue, Stockton, CA 95265-6232 PfiT��rA(y <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www,sicehd.com <br /> ICES <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATIONIPERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AS 1616 (GATTO)) <br /> CFO BmIness Name; Owner Name: Date: <br /> SLk40 Crea?1�2_ -- Abl.00 0baUllid 14-1. 1 ,,�01R <br /> CFO Physk�l Address: . CFO City: CFO Zlp: <br /> 1196L- Vj&jtF Il OFIVe., La'-rxop CA qS33a --- <br /> Website(if-epplicable):m <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only)$133 ijo "Class B"(Direct& Indirect Sales)$265 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br /> Only foods that are defined as"non-potentially hazardous" are approved for preparation by a Cottage Food <br /> Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br /> growth that could be a cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed("Class A"CFOs Only) <br /> 4. Products. <br /> Please check the items you wll7 be preparing and/or selling. <br /> X1 Baked Goods El Dried Pasta ❑ Honey El Popcorn <br /> Popcorn Barts <br /> La Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cortes ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercresm ❑ Buttercream ❑ Flat Icing ❑ Ground <br /> Frostinglieing' Fbndant/Gumpaste` Chocolate <br /> [] Dried Mole Paste ❑ Herbl$pice Blends ❑ Pizzeles ❑ Jams/Jellies- <br /> Nut MixeslNut Fried or Baked <br /> © Fru ItEmpanadas ❑ Fruit Tamales/Pies ❑ Butters -1 Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix!Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples CaramellFridge Elmashmallow <br /> EHQ 18-27 2!3h7 1 CFO REGIPERWrING FORM <br /> Received Tlme Feb. 1. 2018 8:34PM No. 2980 <br />