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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 40k (A3/"Q — <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www sigov org/EHD <br />Pio J ok.k.s/1 /4, <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM -7 5 <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />P-6 . Date: , <br />G q.NrE-forn c-1NJ ,k-roc--euff-E e-ANCt+- t \-)Pnit-Lo Pa2-62- 101/2.if <br />CFO Physical Address: CFO City: CFO Zip: <br />DO-eN e—T 1Y-42-r-A1 cr 7 <br />VVebsite (If applicable): Telephone: <br />/ 51 - <br />Categories: <br />111 "Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: f7A-F <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 />CFO Business Name: Owner Name: <br />Baked Goods <br />LII Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />El Dried Mole Paste <br />Fruit Empanadas <br />III Granola/Cereals <br />Cotton Candy <br />Dried Pasta <br />Dry Baking Mixes <br />El Waffle Cones <br />Buttercream <br />Fondant/Gum paste* <br />Herb/Spice Blends <br />Li Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />Popcorn/ <br />Popcorn Balls <br />El Mustard El Vinegar <br />El Dried Grain Mixes 111 Fruit Butter** <br />El Flat Icing LI <br />Pizzeles El Jams/Jellies"' <br />Fried or Baked <br />E Donuts and <br />Waffles <br />El Trail Mix/ Dried Fruit E Dried Fruit <br />Marshmallows/ <br />111 Marshmallow <br />Bars* <br />Honey <br />Ground <br />Chocolate <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />EHD 16-27 6/29/2023 <br /> 1 CFO REG/PERMITTING FORM