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Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />El Dried Pasta <br />E Dry Baking Mixes <br />Or Waffle Cones"- <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />12/ Fruit Tamales/Pies le0 <br />El Honey <br />El Mustard <br />tJa Dried Grain Mixes <br />1[2(Flat Icing <br />El Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Popcorn/ <br />Popcorn Balls <br />ID Vinegar <br />,21- Fruit Butter** <br />Ground <br />1--1 Chocolate <br />NF:YrJanns/Jellies** <br />/Fried or Baked <br />O Donuts and <br />Waffles <br />El <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 /> <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />5R1 VA7244-) el.0136 <br />CFO Physical Address: <br />2510 RIO CyR4Nve DP <br />Website (If applicable): <br />1. Categories: <br />la' "Class A" (Direct Sales Only) $186 <br />Owner Name: Date: <br />nvyil 1479 LI PFDD1 A(?61 2O2- <br />CFO City: CFO Zip: <br />TRIvy <br />Telephone: <br />5it", ),*-1 I 3.4' o <br />0 "Class B" (Direct & Indirect Sales) $486 <br />qsa 77 <br />Prohibited Items: Initial if you agree to abide by the following: OM <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 />.21" Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Cel/ Dried Fruit .1:2( Granola/Cereals 0 Seasoning Salt .42/ Trail Mix/ Dried Fruit <br />EZ( Cotton Candy 0 Candied Apples <br />EHD 16-27 6/29/2023 1 <br />ci • 10' 2-L1 <br />Phçe <br />2/ Salted <br />Caramel/Fudge <br />/ Marshmallows/ <br />0' Marshmallow <br />Bars* <br />CFO REG/PERMITTING FORM