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SAN JOAQUIN Environmental Health Department - COUNTY— .., ,.otness grows here. COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: Owner Name: Date: queensbakery209 dora escobar 10-5-2022 CFO Physical Address: CFO City: CFO Zip: 259 pestana ave apt 3 manteca 95336 Website(If applicable): Telephone: 209 256 9175 1. Categories: M "Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct&Indirect Sales)$312 2. Prohibited Items: Initial if you agree to abide by the following: D.E. 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. These foods include 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: Please check the items you will be preparing and/or selling. ® Baked Goods ❑ Dried Pasta [__1Honey E] Popcorn/ Popcorn Balls ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** ❑ Buttercream * ElButtercream El Flat Icing ❑ Ground Frosting/Icing Fondant/Gumpaste* Chocolate ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut Fried or Baked ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow Bars* 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd