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Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />LII Herb/Spice Blends <br />LI <br />LI Granola/Cereals LI Seasoning Salt El Trail Mix/ Dried Fruit <br />Ej Cotton Candy LI Candied Apples n Salted <br />Caramel/Fudge <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: www.siqov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name A wner Naze: <br />re, Arno Desse445 tau dick Valc2encick <br />CFO Physical Address: CFO City: <br />10 I M bairn e °kV SiOCkt- <br />ceatk-(2-14 <br />CFO Zip: <br />q 5203 <br />Website (If applicable): Telephone:1109 ) 43 0 _3s77 <br />Categories: <br />[kr "Class A" (Direct Sales Only) $186 E "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 bacterial <br />growth that could be a cause of food-borne illness. <br />"Class A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />E Fruit Empanadas E Fruit Tamales/Pies <br />LI Dried Pasta El Honey <br />ustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />El Popcorn/ <br />Popcorn Balls <br />El Vinegar <br />El Fruit Butter** <br />LI Ground <br />Chocolate <br />LI Jams/Jellies** <br />Fried or Baked <br />LI Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />LI Marshmallow <br />Bars* <br />ftr-- Baked Goods <br />[I7-Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />El Dried Mole Paste <br />M <br />I <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM