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Marshmallows/ <br />Candied Apples Salted 0 Marshmallow <br />Bars* Caramel/Fudge <br />\e,/j- fAeecl 1()1 <br />cii4-5 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.siqov.org/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 />Astro Treats Motuma Teramu & Fiona Teramu 9/27/23 <br />CFO Physical Address: CFO City: CFO Zip: <br />17338 Daffodil Hill St Lathrop 95330 <br />Website (If applicable): Telephone: <br />910-750-1376 <br />Categories: <br /> --el\o(0‘ .-veromrot® b4A‘N1/4-r° ' C'—'k5NOrN <br />EJ "Class A" (Direct Sales Only) $186 E "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: MT/ FT <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 />[A Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />E Baked Goods 0 Dried Pasta 0 Honey Popcorn / <br />Popcorn Balls <br />0 Dry Baking Mixes El Mustard E Vinegar <br />0 Waffle Cones 0 Dried Grain Mixes E Fruit Butter** <br />Buttercream <br />Fondant/Gumpaste* <br />0 Ground <br />El 0 Flat Icing Chocolate <br />Herb/Spice Blends 0 Pizzeles E Jams/Jellies** <br />Fried or Baked Nut Mixes/Nut E 0 Fruit Tamales/Pies Butters 0 Donuts and <br />Waffles <br />Seasoning Salt 0 Trail Mix/ Dried Fruit N Dried Fruit <br />LI <br />IA Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM