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CFO Physical Address: CFO Cit <br />Date: <br />2 <br />CFO Zip: <br />CFO Business Name: <br />o <br />Owner Name: <br />Cre <br />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: wwvv.spov.orq/EHD <br /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />q3 pQC//c A Ve 4,P,Y° 5 fo-c.kX> <br />Website (If applicable): Telephone: <br />29 29' 35-72 <br /> <br />Categories: <br />rj "Class A" (Direct Sales Only) $186 1=1 "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 />LI 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 />1:1 Candy <br />El Churros <br />El Buttercream <br />Frosting/Icing* <br />El Dried Mole Paste <br />CI Fruit Empanadas <br />111 Granola/Cereals <br />IA, Cotton Candy <br />C1 <br />111 <br />El <br />0 <br />1=1 <br />ID <br />CI <br />El <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 />1:1 <br />ID <br />1=1 <br />El <br />El <br />El <br />El <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 <br />111 <br />El <br />El <br />El <br />1:1 <br />CI <br />111 <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Fruit Butter** <br />Ground <br />Chocolate <br />Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 <br /> CFO REG/PERMITTING FORM <br />PR o SLI