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CI Baked Goods 0 Dried Pasta 111 Candy El Churros 111 Buttercream Frosting/Icing" El Dried Mole Paste El Fruit Empanadas El Granola/Cereals 111 Cotton Candy El Dry Baking Mixes 111 Waffle Cones CI Buttercream Fondant/Gumpaste* 111 Herb/Spice Blends CI Fruit Tamales/Pies El Seasoning Salt Candied Apples AZ 2(1 00361D SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East HazeIton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orq/EHD COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Business Name: Owner Name: Date: Tita Dees Deanna-Lynn K Eachus 08/30/2024 CFO Physical Address: CFO City: CFO Zip: 512 S. Hutchins St. Lodi 95240 Website (If applicable): Telephone: 209-269-2490 Categories: 0 "Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 2. Prohibited Items: Initial if you agree to abide by the following: DKE 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) 4. Products: Please check the items you will be preparing and/or selling. 111 111 111 111 111 El El Honey Mustard Dried Grain Mixes Flat Icing Pizzeles Nut Mixes/Nut Butters Trail Mix/ Dried Fruit Salted Caramel/Fudge El Popcorn! Popcorn Balls 111 Vinegar 0 Fruit Butter** Ground El Chocolate 111 Jams/Jellies** Fried or Baked CI Donuts and Waffles El Dried Fruit Marshmallows/ El Marshmallow Bars* END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM