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SAN JOAQUIN COUNTY 2.q 00221 ENVIRONMENTAL HEALTH DEPARTMENT 1868 East HazeIton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orq/EHD COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name:t 6t Owner Name: tyta, pp CFO Physical Address: CFO City: S3 -e 003 S'Atkert Website (If applicable): Telephone: .4ei 7 513 g a? 5 bqt IVO zW4) &Ai (-) 7 Categories: V "Class A" (Direct Sales Only) $186 111 "Class B" (Direct & Indirect Sales) $486 2. Prohibited Items: Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness. "Class A" Self Certification Checklist: Checklist completed ("Class A" CFOs Only) Products: Please check the items you will be preparing and/or selling. El 111 CI El El El 111 Baked Goods Candy Churros Buttercream Frosting/Icing* Dried Mole Paste Fruit Empanadas Granola/Cereals Cotton Candy El 11] 111 El El El El El Dried Pasta Dry Baking Mixes Waffle Cones Buttercream Fondant/Gumpaste* Herb/Spice Blends Fruit Tamales/Pies Seasoning Salt Candied Apples CI El El 111 El El CI El Honey Mustard Dried Grain Mixes Flat Icing Pizzeles Nut Mixes/Nut Butters Trail Mix/ Dried Fruit Salted Caramel/Fudge Popcorn/ El Popcorn Balls El Vinegar 111 Fruit Butter** Ground El Chocolate El Jams/Jellies** Fried or Baked El Donuts and Waffles El Dried Fruit Marshmallows/ ID Marshmallow Bars* Date: .710 /01- CFO Zip: EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM