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Date: ■C Website (If applicable): □“Class B” (Direct & Indirect Sales) $486 2. Prohibited Items: 4. Products: Please check the items you will be preparing and/or selling. □□□ Dried Pasta□HoneyBaked Goods □ Vinegar□□□ Dry Baking Mixes MustardCandy □□ Waffle Cones□Dried Grain MixesChurros □□□□Flat Icing □□ Herb/Spice Blends□PizzelesDried Mole Paste □□ Fruit Tamales/Pies□Fruit Empanadas □ Dried Fruit□□ Seasoning Salt□Trail Mix/ Dried FruitGranola/Cereals □□ Candied Apples□Cotton Candy 1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 Salted Caramel/Fudge Buttercream Frosting/lcing* COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) Buttercream Fonda nt/Gu m paste* Nut Mixes/Nut Butters Popcorn/ Popcorn Balls Ground Chocolate San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siQov.org/EHD CFO Zip: 1. Categories: O' “Class A” (Direct Sales Only) $186 Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-bome illness. Fried or Baked □ Donuts and Waffles Marshmallows/ Q Marshmallow Bars* 3. “Class A” Self Certification Checklist: □ Checklist completed (“Class A” CFOs Only) ( CFO Business Name: yj'hv IS CFO Physical Address: j/bo / Owner Name: CFO City: Telephone: □ Fruit Butter** □ Jams/Jellies**