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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.sibov.orb/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />Supri_bakes <br />Supriya Santhilal <br />04/30/2024 <br />CFO Physical Address: CFO City: CFO Zip: <br />472W San Juan Ct <br /> Mountain House <br />95391 <br />Website (If applicable): Telephone: <br />925-621-9492 <br />Categories: <br />El "Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: ss <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 /> s1 /4 _,\Qr ; esh 3inc'-;\ <br />El Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />LII Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />El Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />El Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />Honey <br />Mustard <br />LI Dried Grain Mixes <br />LI Flat Icing <br />LI Pizzeles <br />Nut Mixes/Nut <br />Butters <br />El Trail Mix/ Dried Fruit <br />n Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />El Fruit Butter** <br />LI Ground <br />Chocolate <br />Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />kokos3ce)ci <br />ii224CO221•