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SAN JOAQUIN COUNTY <br /> Pk2A4 D <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www sigov org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />g(L-4e osc sok: e Shn <br />CFO Physical Address: <br />i031 Tenciln courT <br />Website (If applicable): <br /> <br />Owner Name: Name: Date: <br />I aurcn Larcon <br />CFO City: CFO Zip: <br />Vlanicca qr.-7,2;3-1 <br />Telephone: <br />20 -313 • giog 2 <br /> <br />I. Categories: <br />Ei/ "Class A" (Direct Sales Only) $186 <br /> <br />Li "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 NO L ED. <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 />yi Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />2/ Baked Goods <br />Li Candy <br />Ej Churros <br />Buttercream CI Frosting/Icing* <br />0 Dried Mole Paste <br />Li Fruit Empanadas <br />Li Granola/Cereals <br />E Cotton Candy <br />Et <br />El <br />[II <br />Li <br />Ej <br />DI <br />ID <br />E <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 />El <br />0 <br />LI <br />Li <br />Li <br />Li <br />Li <br />1-1 <br />'—' <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/ Li Popcorn Balls <br />Li Vinegar <br />Li Fruit Butter** <br />Ground CI Chocolate <br />Li Jams/Jellies*" <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />Li Dried Fruit <br />Marshmallows/ <br />E Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM