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Baked Goods <br />Li Candy <br />Li Churros <br />,12/Buttercream <br />Frosting/Icing <br />Ti Dried Mole Paste <br />Fruit Empanadas <br />Li Granola/Cereals <br />Ootton Candy <br />(Neac9--e_ <br />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: ,wiw sigov.orWEHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />OYL,-301 <br />Date CFO Business Name <br />t; on s Lice' e at/JO n <br />Owner Name <br />CFO Physical Address , <br />9- kolj S 14V-C e <br />Website (If applicable) <br />CFO City C 0 Zi <br />cuptct-iri -H ouse <br />Telephone <br />- g2-339 <br />Categories: <br />jir "Class A' (Direct Sales Only) $186 <br /> 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 bacteria <br />arowth that could be a cause of food-borne illness <br />"Class A" Self Certification Checklist: <br />0/Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Li Popcorn! <br />Popcorn Balls Dried Pasta 0 Honey <br />0 Dry Baking Mixes CI Mustard Vineaa7' <br />Li Waffle Cones Dried Grain Mixes Li Fruit Butter <br />Li Flat Icing <br />Li Herb/Spice Blends LI Pizzeles <br />VNut Mixes/Nut <br />Butters <br />0 Trail Mix/ Dried Fruit <br />Marshmallows! <br />Li Marshmallow <br />9ars* <br />Fruit Tamales/Pies <br />0 Seasoning Salt <br />Candied Apples <br />Buttercream <br />FondanUGumpaste* <br />oalted <br />r:aramel/Fudae <br />CI Ground <br />Chocolate <br />Li Jams/Jellies — <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />Dried Fruit <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM