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Baked Goods <br />Candy <br />LI Churros <br />121 Buttercream <br />( Frosting/Icing* <br />El <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />Dried Mole Paste <br />EHD 16-27 6/2912023 <br />zOn <br />/17 <br />p r-15-1 <br />I.1.•• PAO '1 <br />1111,- <br />4e068'0"' <br />0 <br />iNeou- r\ee <br />SAN JOAQUIN COUNTY Pg. <br />ENVIRONMENTAL HEALTH DEPARTMENT '7R 0 S gl-gs <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www sigov org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />F Business Name: <br />Ut) Cir */ <br />O <br /> <br /> <br />wner Name: <br />?i. <br />D <br />Q <br />ate <br />S<Lk\ <br /> <br />- — II ig/ 1 32-3 CFO Physical Address: CFO City: CFO Zip: --, <br /> <br />C A cA5 3 7 t, --1 c 9 c.) he.i \ C. i ---1--(c‹../ , Website (If applicable): Telephone: <br />k,,.) kAA,k • 1.-nA.C,._Skik tt ---CYV\1.:9/k_if _ : 0.4411,4 (_9 e 0 ( 't) --(c0L-i.7 <br />Categories: <br />0 "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: <br />Foods containing bream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br />Only foods that ar 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 />ri4 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 Dried Pasta [II] <br />0 Dry Baking Mixes <br />0 Waffle Cones <br />14 <br />Buttercream <br />Fondant/Gumpaste* <br />E Herb/Spice Blends <br />LII Fruit Tamales/Pies <br />0 Seasoning Salt <br />0 Candied Apples <br />D <br />0 <br />0 <br />0 <br />CJ <br />0 <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 />Ground <br />0 Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />El Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />t Marshmallow <br />Bars* <br />1 CFO REG/PERMITTING FORM <br />cor(T7.1/4-(\j(Dry\cyj. cult-)