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1=1 Dried Pasta <br />Z Dry Baking Mixes <br />[8] Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />CI Herb/Spice Blends <br />111 Fruit Tamales/Pies <br />111 Seasoning Salt <br />111 Candied Apples <br />CI <br />PROS 2 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />Kenzi Sweets <br />Maram Alomari <br /> 09/08/2023 <br />CFO Physical Address: CFO City: CFO Zip: <br />757 N Del Prado St <br />Mountain House 95391 <br />Website (If applicable): Telephone: <br />510.833.3015 sci- °Li 61/41 <br />Categories: <br />111 "Class A" (Direct Sales Only) $186 <br /> CI "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: M.A <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 />E Checklist completed ("Class A" CFOs Only) <br />you will be preparing and/or selling. <br />CI Popcorn/ <br />Popcorn Balls <br />Li Mustard 111 Vinegar <br />Li Dried Grain Mixes 111 Fruit Butter** <br />Ground Li Flat Icing Chocolate <br />111 Pizzeles 111 Jams/Jellies** <br />Fried or Baked Nut Mixes/Nut Z Donuts and Butters Waffles <br />El Trail Mix/ Dried Fruit 111 Dried Fruit <br />Marshmallows/ Ix Salted Z Caramel/Fudge Marshmallow Bars* <br />4. Products: <br />Please check the items <br />X Baked Goods <br />X Candy <br />X Churros <br />X Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />111 Fruit Empanadas <br />111 Granola/Cereals <br />111 Cotton Candy <br />1=1 Honey <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM