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MUSD 2/008 Fax Server <br />RitiUjeAA4 <br />\ a_v <br />A 9"2-40.00 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.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 />&‘41 (12--P1 25-E- <br />CFO Physical Address: CFO City: CFO Zip: <br />\ 2-U1 \-i\ o \-kfL <br />WebsIte (If applicable): Telephone: zo 6:;\ <br />Categories: <br />M' "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 />NLA Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 <br />)-5:1 <br />D <br />El <br />0 <br />O <br />0 <br />0 <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />0 <br />0 <br />I=1 <br />0 <br />El <br />0 <br />0 <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />D <br />D <br />El <br />El <br />El <br />El <br />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 />Popcorn/ El Popcorn Balls <br />0 Vinegar <br />D Fruit Butter** <br />Ground El Chocolate <br />El Jams/Jellies" <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />END 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />8/14/2024 8:59:46 AM PAGE <br />SAN JOAQUIN COUNTY <br />z(-1