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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.sjgov.org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />Cak‘ Cr fvos LIG <br />CFO Physical Address: <br />53 ?2uonanon L. <br />Owner Name:, Date: „ <br />1—kSa Pendry / 2.3o 9Aave,2 / <br />CFO City: I CFO Zip: <br />lAan'oca- ac203(0 <br />Website (If applicable): Telephone: <br />(10 s% <br />Categories: <br />17f "Class A" (Direct Sales Only) $186 I:1 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT LOWED. <br />Only foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food <br />Operation. These foods include items that do not require refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />1$ Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />'VI Baked Goods <br />Candy <br />Cl Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Dried Pasta <br />1:1 Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />I=1 Honey <br />El Mustard <br />Dried Grain Mixes <br />1:1 Flat Icing <br />Pizzeles <br />El Nut Mixes/Nut <br />Butters <br />0 Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />ID Fruit Butter** <br />El Ground <br />Chocolate <br />1:1 Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />CI Dried Fruit <br />Marshmallows/ <br />I:I Marshmallow <br />Bars* <br />0 Fruit Empanadas 1:1 Fruit Tamales/Pies <br />1:1 Granola/Cereals 0 Seasoning Salt <br />0 Cotton Candy El Candied Apples <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />oom