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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.sigov.ord/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CF. Business Name: ,Owner 46, <br />Vj-90 \A.CT 5 t"A Ke Xe k. ( <br />CFO Physical Address: <br />6H\v-c.kaw A <br />n CFO City: <br />14ctitty <br />Date: <br />3 I I 2.-i <br />CFO Zip: <br />s--3 <br />Website (If applicable): Telephone: <br />?-o1- t <br />1. Categories: <br />3114444:L. le-2-n/cc ”L'-'2.5 .1" <br /> <br />\)6 "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: 4f <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 />121 <br />El <br />El <br />El <br />El <br />I=1 <br />1=1 <br />Please check the items you will be preparing and/or selling. <br />Baked Goods CI Dried Pasta El <br />Candy El Dry Baking Mixes CI <br />Churros CI Waffle Cones CI <br />Buttercream 111 Buttercream <br />Frosting/Icing* Fondant/Gumpaste* 111 <br />Dried Mole Paste CI Herb/Spice Blends El <br />Fruit Empanadas 0 Fruit Tamales/Pies n <br />" <br />Granola/Cereals CI Seasoning Salt El <br />Cotton Candy C] Candied Apples 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 Popcorn/ <br />Popcorn Balls <br />CI Vinegar <br />El Fruit Butter** <br />El Ground <br />Chocolate <br />El Jams/Jellies** <br />Fried or Baked <br />1=I Donuts and <br />Waffles <br />CI Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />END 16-27 6/29/2023 <br /> 1 <br /> <br />CFO REG/PERMITTING FORM