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8._ Baked Goods <br />Candy <br />LI Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />LI Fruit Empanadas <br />Granola/Cereals <br />0 Cotton Candy <br />LI <br />SAN JOAQUIN <br />COUNTY <br />Greotoccs cirovvs here. <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />BotgeyA-1 TIlrfe:Thitn.4-9 One. Ktor WcurC1 <br />CFO Physical Address: CFO City: CFO Zip: <br />Pla11(P lq ,"T-cun Ck Louzk Ft,rct coi 3-7 <br />Website (If applicable): Telephone: <br />N ) C(C:1"Na) Wanini fi'54-tydap,000 (.00 ---la40A0 <br />ark4 anLe...sb(510 bak Categories: <br />g "Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: -TAD <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br />that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food-borne illness. <br />"Class A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) Thrte \-1/Verl-kt <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Date: <br />Z/2—I I Z5 <br />D <br />LI <br />0 <br />LI <br />0 <br />El <br />0 <br />0 <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />0 <br />0 <br />0 <br />0 <br />LI <br />D <br />n <br />`--1 <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />Popcorn/ LI Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />Ground LI Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />El Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd