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Please check the items you will be preparing and/or selling. <br />id Baked Goods 0 Dried Pasta El Honey <br />0 Candy I=1 Dry Baking Mixes 0 Mustard <br />El Churros El Waffle Cones 0 Dried Grain Mixes <br />Buttercream 0/Buttercream <br />Frosting/Icing* Fondant/Gurnpaste" El Flat Icing <br />0 Dried Mole Paste El Herb/Spice Blends El Pizzeles <br />El Fruit Empanadas 0 Fruit Tamales/Pies El Nut Mixes/Nut <br />Butters <br />El Granola/Cereals 0 Seasoning Salt El Trail Mix/ Dried Fruit <br />0 Cotton Candy 0 Candied Apples El " <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />El Vinegar <br />El Fruit Butter** <br />El <br />0 Jams/Jellies" <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />Ground <br />Chocolate <br />PC- 0 5 2.04o <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sicehd.com <br />SAN JOAQUIN COUNTY FPr ooz\-1 igs <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name:.1 Owner Name: Date: 4 <br />Oes •r175 al'oa o `e/o/Po ka3 <br />CFO Physical Address: CFO City: <br />L155 C bbel /VP e <br /> <br />CFO Zip: <br />nkkYkit.(") Ho 19_-3 <br />3e))05-15 <br /> <br />Website (If applicable): Telephone <br /> <br />1. Categories: of\c)\ ho-k--mo.;\ I. (-ow\ <br /> <br />"Class A" (Direct Sales Only) $186 CI "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: <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 />"Checklist completed ("Class A" CFOs Only) <br />Products: <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />-47\p- koko Lr orS2.3