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SAN JOAQUIN COUNTY <br /> PRo <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton 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 />CFO Business Name: <br />FREEZYFROSTYLLC <br />CFO Physical Address: <br />79 N Menlo Park St <br />Owner Name: Date: <br />Patricia Vermilus 11/02/2023 <br />CFO City: CFO Zip: <br />Mountain House <br /> 95391 <br />Website (If applicable): Telephone: <br />www.freezyfrosty.corn <br /> 209-321-1817 <br />Categories: <br />E "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: PV <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 />II] Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Popcorn/ <br />Popcorn Balls fid Baked Goods <br />2 Candy <br />Churros <br />Buttercream <br />Frosting/Icing" <br />LII Dried Mole Paste <br />IN Fruit Empanadas <br />Xl Granola/Cereals <br />NI Cotton Candy <br />Dried Pasta <br />LI Dry Baking Mixes <br />VVathe Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />Honey LI <br />LI Mustard E Vinegar <br />Dried Grain Mixes 0 Fruit Butter** <br />XI Flat Icing LII <br />EI Pizzeles • Jams/Jellies"* <br />Nut Mixes/Nut <br />Butters <br />Fried or Baked <br />Donuts and <br />Waffles <br />2 Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />Ground <br />Chocolate <br />Salted <br />Caramel/Fudge <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM