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SAN JOAQUIN Environmental Health Department <br />COUNTY - <br />A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 <br />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. Only <br />foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food -borne illness. <br />3. "Class A" Self Certification Checklist: <br />M Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />,! Please check the items you will be preparing and/or selling. <br />Lys Baked Goods C] Dried Pasta C] Honey El Po <br />P c Balls <br />r7 Candy <br />❑ Churros <br />COTTAGE FOOD OPERATIONS (CFO) <br />❑ <br />Frosting/icing' <br />REGISTRATION/PERMITTING FORM <br />Dried Mole Paste <br />❑ <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />Owner Name: <br />Date: <br />Urban Icing <br />Britney Hussman <br />5/27/2022 <br />CFO Physical Address: <br />CFO City: <br />CFO Zip: <br />384 Farinelli Parkway <br />Escalon <br />95320 <br />Webslte (If applicable): <br />Telephone: <br />❑ <br />_ <br />209-818-8952 <br />A" (Direct Sales Only) $155 ❑ "Class B" (Direct & Indirect Sales) $310 <br />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. Only <br />foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food -borne illness. <br />3. "Class A" Self Certification Checklist: <br />M Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />,! Please check the items you will be preparing and/or selling. <br />Lys Baked Goods C] Dried Pasta C] Honey El Po <br />P c Balls <br />r7 Candy <br />❑ Churros <br />El <br />Buttercream <br />❑ <br />Frosting/icing' <br />❑ <br />Dried Mole Paste <br />El <br />Dry Baking Mixes <br />❑ <br />Waffle Cones <br />ElButtercream <br />Mustard <br />❑ <br />Fondanf/Gumpaste• <br />E]Herb/Spice <br />Blends <br />El Fruit Empanadas E] Fruit Tamales/Pies <br />F_]Granola/Cereals ❑ Seasoning Salt <br />❑ Cotton Candy ❑ Candied Apples <br />❑ Dried or Dehydrated 1-1DriedVegetarian- <br />Vegetables Based Soup Mixes <br />❑ Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />op om <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />E] <br />Flat Icing <br />El <br />Chocolate Chocolate <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies" <br />Fried or Baked <br />ElButters <br />Nut Mixes/Nut <br />E3 <br />Donuts and <br />Waffles <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Marshmallows/ <br />El <br />Salted <br />El <br />Marshmallow <br />Caramel/Fudge <br />C <br />Bars <br />❑ Vegetable and Potato Chips <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />