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oCli 416-4 <br />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 sjoov orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />Dogtown Cottage Kitchen <br />CFO Physical Address: <br /> <br />Owner Name: Date: <br />Pamela George 2-20-2024 <br />CFO City: uo Zip: <br /> <br />24400 N Jack Tone Rd Acampo, CA 95220 <br />VVebsite (If applicable): Telephone: <br />209-224-4348 <br />Categories: <br />"Class A" (Direct Sales Only) $186 E "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: PG <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 />E Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Baked Goods <br />Candy <br />12 Churros <br />Buttercream <br />Frosting/Icing* <br />I=1 Dried Mole Paste <br />El Fruit Empanadas <br />Granola/Cereals <br />El Cotton Candy <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />L-1 Fondant/Gumpaste" <br />El Herb/Spice Blends <br />E Fruit Tamales/Pies <br />12 Seasoning Salt <br />Candied Apples <br />1=1 Honey <br />LI Mustard <br />LI Dried Grain Mixes <br />LI <br />Flat Icing <br />LI Pizzeles <br />LI Nut Mixes/Nut <br />Butters <br />El Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />El Vinegar <br />El Fruit Butter** <br />Ground <br />Chocolate <br />E Jams/Jellies' <br />Fried or Baked <br />Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM