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?k 0 sk-I Viv <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.siqov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />Shuga Momma Cakes and Cupcakes Laura Padilla 01/22/2024 <br />CFO Physical Address: CFO City: CFO Zip: <br />26735 Airport Ct Manteca, CA 95337 <br />Website (If applicable): Telephone: <br />shuga-momma-cakes.square.site 209-278-7572 <br />Categories: <br />"Class A" (Direct Sales Only) $186 LI "Class B" (Direct & Indirect Sales) $486 <br />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 />V Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods LI Dried Pasta El Honey LI Popcorn/ <br />Popcorn Balls <br />Candy Dry Baking Mixes El Mustard LI Vinegar <br />Churros V Waffle Cones [11 Dried Grain Mixes 111 Fruit Butter** <br />Buttercream <br />Frosting/Icing* <br />Buttercream <br />Fondant/Gumpaste* Flat Icing ▪ Ground V Chocolate <br />El Dried Mole Paste El Herb/Spice Blends LI Pizzeles El Jams/Jellies** <br />Fruit Empanadas 111 Fruit Tamales/Pies <br />111 Granola/Cereals LI Seasoning Salt <br />Cotton Candy 111 Candied Apples <br />n Nut Mixes/Nut <br />'I Butters <br />Fried or Baked <br />111 Donuts and <br />Waffles <br />LI Trail Mix/ Dried Fruit LI Dried Fruit <br />Marshmallows/ <br />2 Marshmallow <br />Bars* <br />n Salted <br />Caramel/Fudge <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM