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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.sloov.oru/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name:Lik, jam amOwnei-4Name: Date: ayt, <br />CFO Zip: <br />1/4/2d,cf <br />te 01; q5 <br />VVebsite (If applicable): Telephone: z <br />1. Categories: <br />111: "Class A' (Direct Sales Only) $186 "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 />11 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />za0 47.(c <br />CFO Physical Address: CFO City: <br />tJ Baked Goods E Dried Pasta <br />[1] C• andy <br />LI C• hurros <br />Buttercream <br />Frosting/Icing" <br />LI Dried Mole Paste <br />LI Fruit Empanadas <br />El G• ranola/Cereals <br />LI Cotton Candy <br />EHD 16-27 6129/2023 <br />E Dry Baking Mixes <br />1=1 Waffle Cones <br />Li Buttercream <br />Fondant/Gumpaste* <br />El Herb/Spice Blends <br />Li Fruit Tamales/Pies <br />E Seasoning Salt <br />E Candied Apples <br />E Honey <br />Li Mustard <br />E Dried Grain Mixes <br />Li Flat Icing <br />Li Pizzeles <br />Nut Mixes/Nut <br />1_1 Butters <br />E Trail Mix/ Dried Fruit <br />Li Salted <br />Caramel/Fudge <br />Li Popcorn/ <br />Popcorn Balls <br />El Vinegar <br />E Fruit Butter** <br />Ground <br />Chocolate <br />Et. Jams/Jellies' <br />Fried or Baked <br />E Donuts and <br />Waffles <br />El Dried Fruit <br />Marshmallows/ <br />E Marshmallow <br />Bars" <br />1 CFO REG/PERMITTING FORM <br />liZosiL4 Licip