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o <br />Website (If applicable): <br />Owner Name: <br />CFO City: <br />Telephone: <br />Date: I\ -)r <br />CFO Zip: <br />q.30 <br />K\10CLI <br />LO\t‘rop <br />_ <br />CFO Business Name: • <br />s <br />CFO Physical Address: <br />\I-W) CNoc V\t‘ci <br />SAN JOAQUIN COUNTY f\ew— (\Qc-f'lZ <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sligov.org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Categories: n 0\6 rpo <br />\12( "Class A" (Direct Sales Only) $186 n "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: t Initial if you agree to abide by the following: <br /> <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br />Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br />Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />\eChecklist completed ("Class A CFOs Only) <br />Products: <br /> <br /> ENVIRONMENTAL HEt-ki <br />PER <br />Please check the items you will be preparing and/or selling. <br />RECEIVLI-1 <br />SEP 1 1 2023 <br />\Kfl Baked Goods <br />ri Candy <br />fl Churros <br />Buttercream LI Frosting/Icing* <br />El Dried Mole Paste <br />LI Fruit Empanadas <br />LIII Granola/Cereals <br />El Cotton Candy <br />LII <br />LII <br />LIII <br />LI <br />El <br />E] <br />LI <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 />LI <br />El <br />El <br />D <br />LI <br />El <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 />111 <br />[1] <br />LI <br />D <br />LI <br />LI <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Fruit Butter** <br />Ground <br />Chocolate <br />Jams/Jellies — <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM