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Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Popcorn/ <br />Popcorn Balls <br />CI Vinegar <br />0 Fruit Butter* <br />LI <br />* <br />Ground <br />Chocolate <br />LI Jams/Jellies"" <br />Fried or Baked <br />LI Nut Mixes/Nut D Donuts and Butters Waffles <br />LI Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />CI Marshmallow Caramel/Fudge Bars* <br />CFO REG/PERMITTING FORM <br />LI Salted <br />9 IN. SAN J OAQU IN 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.sig_oiL.TALHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Nape.Date- - — roc -1?; <br />Name: <br />en I a I Gr <br />CFO CilLo 4 I, CFO Zip: CFO Physical Address: <br />e .35 S 0-ILA r ch 2z1Z2 <br />Website (II applicable): Telephone: <br />W tAlW 14/1 endSprimr. (Oen <br />Cateaories: <br />"Class A' (Direct Sales Only) $186 0 "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 />D Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods CI Dried Pasta <br />Candy 0 Dry Baking Mixes <br />LI Churros 0 Waffle Cones <br />LI Buttercream LI Buttercream <br />Frosting/Icing" Fondant/Gumpaste* <br />0 Dried Mole Paste 0 Herb/Spice Blends <br />0 Fruit Empanadas LI Fruit Tamales/Pies <br />0 Granola/Cereals 0 Seasoning Salt <br />LI Cotton Candy LI Candied Apples <br />EHD 16-276/29i2023 <br />TRost4 stioq