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El Jams/Jellies** <br />Fried or Baked <br />21, Nut Mixes/Nut ad Donuts and Butters Waffles <br />Trail Mix/ Dried Fruit • Dried Fruit <br />rvri Salted <br />Caramel/Fudge <br />Marshmallows/ <br />RI Marshmallow <br />Bars* <br />LI Honey <br />DI Mustard <br />El Dried Grain Mixes <br />Ig Flat Icing <br />LI Pizzeles <br />Popcorn/ <br />Popcorn Balls <br />1:1 Vinegar <br />ID Fruit Butter** <br />El <br />Ground <br />Chocolate <br />SANJOAQUIN <br />--COUNTY-- <br />, Gr otness 9rows here. <br />Rew-- r\eeek <br />Environmental Health Department <br />RECEIVED <br />SEP 1 if 2023 <br />COTTAGE FOOD OPERATIONS (CFO) ENVIRONMENTAL HEALTH <br />REGISTRATION/PERMITTING FORM PERMIT/SERVICES <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Date: <br />1 2.-° <br />CFO Zip: <br />9S391 <br />Categories: <br />fig Class A" (Direct Sales Only) $186 <br />Prohibited Items: <br />1:1 "Class B" (Direct & Indirect Sales) $312 <br /> <br />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. 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 />21 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />CFO Business Name: Owner Name: <br />ONO LI S-Cfkil— &its ple-wk 1-ttRAI4ANDI4N1 <br />CFO Physical Address: <br />43 E CRTA-140 A-VE <br />Website (If applicable): <br /> <br />CFO City: <br />114 ki :4 TA iN 4o i; <br />Telephone: <br />çc 6 Li too <br /> <br />Baked Goods <br />IXI Candy <br />LI Churros <br />Buttercream <br />Frosting/Icing* <br />cl Dried Mole Paste <br />1:1 Fruit Empanadas <br />Granola/Cereals <br />LI Cotton Candy <br />E] Dried Pasta <br />21 Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />LI Seasoning Salt <br />I=1 Candied Apples <br />IX] <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd