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(�eW, neQ>a2 Qe SAN J OA Q U I N Environmental Health Department —COUNTY Greotnes< - COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: Owner Name: Date: Milk & Honey Mia Thurman February 27th, 2023 CFO Physical Address: CFO City: CFO Zip: 712 Ann Gabriel Ln. Tracy 95377 Website (If applicable): Telephone: 1. Categories: V2.ri0c..%t ® "Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct & Indirect Sales) $312 O�t"iLf�AI�E 2. Prohibited Items: Initial if you agree to abide by the following: OK 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 he preparing and/or selling. ❑x Baked Goods El Dried Pasta El Honey El Popcorn Balls Popcorn ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter** Buttercream El Buttercream EK EK Flat Icing El Ground Ground Frosting/Icing* ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** Nut Mixes/Nut Fried or Baked ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ gutters El Donuts and Waffles ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/ Dried Fruit ❑ Dried Fruit Salted Marshmallows/ ❑ Cotton Candy ❑x 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 FRb5g9305_ 5