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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton. CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwsiqov.org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name <br />Oh& CODkieS <br />C Physical Address. <br /> <br />Owner Name <br />VIT—fA 4r2-00 <br />CFO City. <br />Li vi ak-c*, <br />Telephone <br /> <br />Date <br />(11 12-0 2-9 <br />CFO Zip: <br />415 SS CA <br /> <br />Webske (If applicable) <br /> <br />101-o) <br />Categories: <br />VI -Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: <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 />2/Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />ID7Baked Goods El <br />0 <br />0 <br />LI <br />0 <br />Li <br />LI <br />ID <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 />El <br />ID <br />[31 <br />[3 <br />LI <br />LI <br />LI <br />LI <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/ 0 Popcorn Balls <br />LI Vinegar <br />LI Fruit Butter"" <br />Ground LI Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />EHO 1e-27 6/290023 1 CFO REOPERMITTING FORM <br />l=j Candy <br />fl Churros <br />Buttercream <br />Frosting/Icing" <br />0 Dried Mole Paste <br />[I3 Fruit Empanadas <br />0) Granola/Cereals <br />[1 Cotton Candy