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SAN JOAQUIN COUNTY <br /> W2.50o2.sol <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: Owner Name: Date: <br />INDA'S KITCHEN <br /> <br />OBED S GALANG <br />12/11/2024 <br />CFO Physical Address: CFO City: <br />CFO Zip: <br />8667 Mariners Drive. Unit 7 Stockton 95219 <br />Website (If applicable): Telephone: <br />209 451 2847 <br />Categories: <br />El "Class A" (Direct Sales Only) $186 D "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 NOTALLOWED. <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 />21 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Candy <br />LI Churros <br />Buttercream <br />Frosting/Icing* <br />D Dried Mole Paste <br />fl Fruit Empanadas <br />ID Granola/Cereals <br />D Cotton Candy <br />IEI Dry Baking Mixes <br />1E1 Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />LI Herb/Spice Blends <br />11 Fruit Tamales/Pies <br />LI Seasoning Salt <br />DI Candied Apples <br />1=1 Mustard <br />LI Dried Grain Mixes <br />ID Flat Icing <br />D Pizzeles <br />LI <br />LI Trail Mix/ Dried Fruit <br />LI Salted <br />Caramel/Fudge <br />LI Popcorn/ <br />Popcorn Balls <br />El Vinegar <br />El Fruit Butter** <br />LI <br />21 Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />1=1 Dried Fruit <br />Marshmallows/ <br />El Marshmallow <br />Bars* <br />11 Baked Goods <br />I] Dried Pasta El Honey <br />LI LI <br />Nut Mixes/Nut <br />Butters <br />Ground <br />Chocolate <br />1 CFO REG/PERMITTING FORM EHD 16-27 6/29/2023