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Buttercream <br />Frosting/Icing* LI <br />n Seasoning Salt Trail Mix/ Dried Fruit ▪ Dried Fruit <br />lE Candied Apples ni Salted <br />I—I Caramel/Fudge <br />Marshmallows/ <br />Marshmallow <br />Bars* <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.sidov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />Antojitos Hechos Con Amor <br />Owner Name: Date: <br />Liliana Carrasco <br /> ((I 1912-9 <br />CFO City: CFO Zip: <br />Stockton 95210 <br /> <br />CFO Physical Address: <br />525 W. Iris Ave <br /> <br />Website (If applicable): Telephone: <br />209-670-7046 <br />Categories: <br />1= "Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: LC <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 />1= Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Popcorn/ <br />Popcorn Balls Baked Goods <br />LI Candy <br />Churros <br />LI <br />Dried Mole Paste <br />IN Fruit Empanadas <br />El Granola/Cereals <br />Li Cotton Candy <br />1=1 Dried Pasta <br />LI Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />El Fruit Tamales/Pies <br />Li Honey LI <br />I=1 Mustard 0 Vinegar <br />El Dried Grain Mixes El Fruit Butter** <br />LI Flat Icing LII <br />Pizzeles Li Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />Ground <br />Chocolate <br />Nut Mixes/Nut <br />Butters <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM