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r\-Q-Qck_ <br />TR ost-1131w 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.sigov.oro/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business \lame:. Owner Name: <br />If\ `+ (C. Akc re) <br />CFO City: <br />LC,40 f .t) <br />Telephone: <br />LF.2 '-11 <br />Otktk <br />CFO Physical Address: j <br />2-11 V)C:ViA6) <br />Website (If applicable): <br />\- t 1+-4310jv <br />Date: <br />\) Ze'L <br />CEO Zip: <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: <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 />D/Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods <br />Candy <br />Li Churros <br />Er Buttercream <br />Frosting/Icing* <br />Ill Dried Mole Paste <br />D Fruit Empanadas <br />DI Granola/Cereals <br />Er Cotton Candy <br />LI <br />D <br />El <br />Li <br />D <br />Li <br />D <br />DJ <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />CI Honey <br />Li Mustard <br />Li Dried Grain Mixes <br />Er Flat Icing <br />Li Pizzeles <br />Li Nut Mixes/Nut <br />Butters <br />C] Trail Mix/ Dried Fruit <br />El Salted <br />1---1 Caramel/Fudge <br />/Popcorn/ <br />Popcorn Balls <br />Li Vinegar <br />0 Fruit Butter** <br />Ground Li Chocolate <br />Li Jams/Jellies** <br />Fried or Baked <br />Li Donuts and <br />Waffles <br />DI Dried Fruit <br />Marshmallows/ <br />D Marshmallow <br />Bars" <br />EVID 16-27 6/29/2023 1 CFO REG/PERMITTING FORM