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s--itsOci 9 <br />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 siclov 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 <br />fa 19 FrtC K‘r L-st If W h r <br />CFO Physical Address CFO City CFO Zip <br />OS 2_ Ctt met vkv‘e CX --105rfrtti L.thrz p d1 533 0 <br />Website (If applicable) Telephone <br />Nlrk 2.°L1 kl <br />1. Categories: <br />"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: Ill\A) <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 El Dried Pasta <br />NI Candy <br />Churros <br />Eli Dry Baking Mixes <br />LI Waffle Cones <br />LI Buttercream <br />Fondant/Gumpaste* <br />0 Herb/Spice Blends <br />Buttercream <br />Frosting/Icing <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Fruit Butter** <br />Ground <br />Chocolate <br />Jams/Jellies** Dried Mole Paste <br />Fried or Baked <br />Donuts and <br />Waffles <br />Honey <br />Mustard <br />LI Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />LI Nut Mixes/Nut <br />Butters <br />Fruit Empanadas 0 Fruit Tamales/Pies <br />Granola/Cereals 0 Seasoning Salt <br />Cotton Candy D Candied Apples <br />Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />X Marshmallow <br />Bars* <br />Salted <br />Caramel/Fudge <br />EHD 16.27 6/29/2023 1 CFO REG/PERMITTING FORM