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Owner Name: <br />V (Ivo Ctr)e, bo n°4 icx <br />CFO City: <br />5 to c‘M-on <br />Date: <br />5/0/3 <br />CFO Zip: <br />Cl 5q04h <br />CFO Business Name: • D COYAZOn <br />CFO Physical Address: <br />LI °LI E cl cvnd 34- <br />Baked Goods 1=I Dried Pasta LI Honey El <br />Ground <br />Chocolate <br />1:1 Dry Baking Mixes <br />El Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />111 Herb/Spice Blends <br />LI Fruit Tamales/Pies Nut Mixes/Nut <br />Butters <br />LI Seasoning Salt <br />.13f <br />Candy <br />El Chu rros <br />Buttercream <br />Frosting/Icing* <br />111 Dried Mole Paste <br />n Fruit Empanadas <br />Granola/Cereals <br />Popcorn/ <br />Popcorn Balls <br />1=1 Mustard LI Vinegar <br />111 Dried Grain Mixes LI Fruit Butter** <br />k Flat Icing 111 <br />LI Pizzeles LI Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />LI Trail Mix/ Dried Fruit 111 Dried Fruit <br />SANAAOUIN <br />COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Website (If applicable): <br />Karl) 1%nebog:Ilat 7,3 t 9m cZ'‘ T <br />elephoner2 °CO 3 14 <br />5C1 CI <br />Categories: <br />izt "Class A" (Direct Sales Only) $186 111 "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: 16 <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 />El Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />111 Cotton Candy 'K. Candied Apples 111 Salted <br />Caramel/Fudge <br />Marshmallows/ <br />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