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SAN JOAQUIN COUNTY <br /> PR 0 9-qijS - <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.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: <br />'by rev% Gul• <br /> <br />Date: <br />11.'7 2b2-% <br />CFO Zip: <br />q <br /> <br />fish N Trerckvia tic <br /> <br />CFO Physical Address: <br />1550 v.1, nnct.Cin <br /> <br />CFO City: s <br />zio 12) pegn <br />Telephone: <br /> <br />Website (If applicable): <br /> <br />40 &I • 233 ' t12--t4 <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: WI <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 />111 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Baked Goods CI Dried Pasta <br />cg, Candy 111 Dry Baking Mixes <br />El Churros El Waffle Cones <br />CI Buttercream <br />Frosting/Icing* El Buttercream <br />Fondant/Gumpaste* <br />El Dried Mole Paste CI Herb/Spice Blends <br />1=1 Fruit Empanadas C) Fruit Tamales/Pies <br />0 Granola/Cereals 0 Seasoning Salt <br />El Cotton Candy 0 Candied Apples <br />1=1 <br />CI <br />El <br />111 <br />111 <br />El <br />Ell <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 />Popcorn/ CI Popcorn Balls <br />El Vinegar <br />111 Fruit Butter** <br />Ground CI Chocolate <br />0 Jams/Jellies** <br />Fried of Baked <br />El Donuts and <br />Waffles <br />[1] Dried Fruit <br />Marshmallows/ <br />[)4 Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM