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nt+ �R[" SAN JOAQUIN COUNTY�• �l�os`i+�l 33 <br /> W. , ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglEHD <br /> 11 <br /> Q COTTAGE FOOD OPERATIONS (CFO) <br /> OREGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Date: <br /> a. EL Nenes Wonder Cookies David Macias-Campos Ill Jan 30,2025 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 166 Haller Ct Ripon,CA 95366 <br /> Website(If applicable): Telephone: <br /> 209-408-7418 <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $186 "Class B" (Direct& Indirect Sales)$486 <br /> DMC <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 /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class A" CFOs Only) ro?l <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter— <br /> El Buttercream Ground <br /> ❑ Frosting/icing* ❑ Fondant/Gumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies** <br /> Nut MixesiNut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> EHD 16-27 6/29/2023 1 CFQ REWPERMITTiNG FORM <br /> COPY <br />