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r\ee6s <br />Environmental Health Department <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />SANIJOAQUIN <br />COUNTY— <br />Greatness grows here. PAYMENT <br />RECEIVED <br />JAN 2 4 2024 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT, <br />CFO Business Name: Owner Name: <br />'Braes 10% LIAItA) Lvi114 illesq,u(A-/A <br />CFO Physical Addritiss: CFO Cityl/ <br />Wel MareAwry& Tra <br />Date: <br />CFO Zip: <br />153.31Q <br />Website (If applicable): <br />hate-, <br /> <br />Teleph <br />(57 9 550 <br /> <br />C te ories: <br />"Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $312 <br />2. Prohibited Items: Initial if you agree to abide by the following: Lv <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br />that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food-borne illness. <br />"C ,Js A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El <br />El <br />El <br />El <br />El <br />El <br />CI <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />El Dried Pasta <br />El Dry Baking Mixes <br />El Waffle Cones <br />Buttercream E Fondant/Gumpaste* <br />111 Herb/Spice Blends <br />111 Fruit Tamales/Pies <br />I=1 Seasoning Salt <br />El Candied Apples <br />El <br />El <br />CI <br />I=1 <br />El <br />El <br />El <br />ni <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 />El Popcorn/ <br />Popcorn Balls <br />D Vinegar <br />El Fruit Butter** <br />Ground El Chocolate <br />El Jams/Jellies — <br />Fried or Baked <br />111 Donuts and <br />Waffles <br />1=I Dried Fruit <br />Marshmallows/ <br />1=I Marshmallow <br />Bars* <br />1868 E. Hazelton Avenue I Stockton, California 95205 l T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />VO5'\113