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LI Honey <br />El Mustard <br />Dried Grain <br />0 Flat Icing <br />LI Pizzeles <br />LI Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Mixes LI Fruit Butter** <br />Ground <br />Chocolate <br />Jams/Jellies"'' <br />Fried or Baked <br />Donuts and <br />Waffles <br />D Trail Mix/ Dried Fruit • Dried Fruit <br />Salted Marshmallows/ <br />LI D Caramel/Fudge Marshmallow Bars* <br />n Nut Mixes/Nut <br />Butters <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows he-- <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />PAYMENT <br />RECEIVED <br />JAN 2 4 2024 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT, <br />Environmental Health Department <br />CO Business Name: Owner Name: Date: <br />jotj 1_10 Lik,/ Lvi Iii fYi e 5(414/thk.,., <br />CFO Physical Address: CFO cityl/ CFO Zip: <br />(Q) I OA 0, re-111 rçf C 53 -Tip <br />Website (If applicable): Telepti. <br />(51 <br /> <br />cl ')50 <br /> <br />1. Categories: <br />"Class A" (Direct Sales Only) $186 D "Class B" (Direct & Indirect Sales) $312 <br />Initial if you agree to abide by the following: LS Ail <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 />"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 />2. Prohibited Items: <br />c] Baked Goods 0 Dried Pasta <br />1:1 Candy LI Dry Baking Mixes <br />0 Churros LI Waffle Cones <br />El Buttercream <br />Frosting/Icing* LI Buttercream <br />Fondant/Gumpaste* <br />D Dried Mole Paste LI Herb/Spice Blends <br />D Fruit Empanadas LI Fruit Tamales/Pies <br />LI Granola/Cereals LI Seasoning Salt <br />LI Cotton Candy 111 Candied Apples <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 F 209 464-0138 I www.sjgov.org/ehd <br />PRo5Lliqs3