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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: 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: , 1 i <br />e-,e_hroel Rik on tobbi nakr.5, go4 rtiu Ft-r-a n_.i sch 1 rvi <br />CFO Physical Address: CFO City: CFO Zip: <br />1 1 4-1--L; 01 t VA) Will 3-i -ce_Kron qc3-7f1 <br />Website (If applicable): Telephone: <br />Log 40(p eci'M 1 <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: <br />, <br />Initial if you agree to abide by the following: <br /> <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 />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Candy <br />LI Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />El Fruit Empanadas <br />Granola/Cereals <br />0 Cotton Candy <br />0 Dry Baking Mixes <br />0 Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />0 Herb/Spice Blends <br />0 Fruit Tamales/Pies <br />El Seasoning Salt LI <br />Popcorn/ <br />Popcorn Balls <br />LI Vinegar <br />Mixes 0 Fruit Butter** <br />LI Ground <br />Chocolate <br />Jams/Jellies** <br />Fried or Baked <br />LI Donuts and <br />Waffles <br />Trail Mix/ Dried Fruit 0 Dried Fruit <br />LI LI <br />Baked Goods El Dried Pasta ID Honey LI <br />LI Mustard <br />Dried Grain <br />0 Flat Icing <br />LI Pizzeles <br />1---1 Nut Mixes/Nut <br />1--1 Butters <br />111 Candied Apples n Salted <br />" Caramel/Fudge <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM