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El <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.sioov.orWEHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business N,ame: <br />10(In(45 Oarden <br />CFO Physical Address: <br />P1),119(15e <br />Website (If applicable): <br />OwneSel CtedS <br />C Ft35' CI?:a 61( <br />TelePne <br />61) LI al 5 V) <br /> <br />C9aF tbiapii <br />ccoPzo <br /> <br />ate ories: <br />"Class A" (Direct Sales Only) $186 El "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 />0 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods 0 Dried Pasta <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />El Dry Baking Mixes <br />Waffle Cones <br />El Buttercream <br />Fondant/Gumpaste* <br />V Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />D Honey <br />El Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />El Nut Mixes/Nut <br />Butters <br />El Trail Mix/ Dried Fruit <br />El Salted <br />Caramel/Fudge <br />El Popcorn/ <br />Popcorn Balls <br />El Vinegar <br />0 Fruit Butter** <br />C1 <br />0 Jams/Jellies — <br />Fried or Baked <br />CI Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />El Marshmallow <br />Bars* <br />Ground <br />Chocolate <br />END 16-27 6/29/2023 <br />TyucA,1,1 <br />r4-2F2_200_ <br />RECPVED <br />JUN 10 2024 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />CFO REG/PERMITTING FORM