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Date: <br />Telephone: <br />7^03/7: <br />"Class B" (Direct & Indirect Sales) $486"Class A" (Direct Sales Only) $186 <br />Jtz <br />H7 Dried Pasta HoneyBaked Goods <br /> Vinegar Dry Baking Mixes MustardCandy <br /> Fruit Butter' Waffle Cones Dried Grain MixesChurros <br />Flat Icing <br />0^ Jams/Jellies‘* Herb/Spice Blends PizzelesDried Mole Paste <br /> Fruit Tamales/PlesFruit Empanadas <br />Trail Mix/Dried Fruit Dried Fruit Seasoning SaltGranola/Cereals <br /> Candied ApplesCotton Candy <br />CFO REG/PERMITTING FORM1EHD 16-27 6/29/2023 <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mlxes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Ground <br />Chocolate <br />Popcorn/ <br />Popcorn Balls <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/EHD <br />CFO Zip: <br />Owner Name: . . / <br />JaAitr A/- <br />CFO City: <br />y-Zoc/<-7o/l <br />Marshmallows/ <br /> Marshmallow <br />Bars* <br />Fried or Baked <br /> Donuts and <br />Waffles <br />1. Categories: <br />CFO Business Name: <br />3 V half Mfs mmshoP <br />CFO Physical Address: <br />f O ? //a <br />Website (If applicable): <br />3. “Class A” Self Certification Checklist: <br /> Checklist completed (“Class A" CFOs Only) <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-bome illness. <br />4. Products: <br />Please check the items you will be preparing and/or selling.