Laserfiche WebLink
I <br />S, Baked Goods <br />0 Candy <br />D Churros <br />El Buttercream <br />Frosting/Icing" <br />El Dried Mole Paste <br />ID Fruit Empanadas <br />Granola/Cereals <br />El Cotton Candy <br />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.siqov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />1104150 01-140 ifeCie( <br /> <br />Owner Name: Date: <br />NUICNietk EYtV1 QtleVeCIO IV <br /> <br />CFO Physical Address: <br /> <br />CFO City: City: CFO Zip: <br /> <br />9-bcktDA 61.5z0 <br />Website (If applicable): Telephone: <br />417 -1.3* <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "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 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 />‘t$7 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />0 Dried Pasta <br />0 Dry Baking Mixes <br />El Waffle Cones <br />Buttercream CI Fondant/Gumpaste* <br />0 Fruit Tamales/Pies <br />0 Seasoning Salt <br />0 Candied Apples <br />0 <br />0 <br />0 <br />Er] <br />0 <br />El <br />ci <br />El <br />Herb/Spice Blends Jams/Jellies" <br />E <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />El Popcorn/ El Popcorn/ <br />Popcorn Balls Popcorn Balls <br />El Vinegar El Vinegar <br />El Fruit Butter—El Fruit Butter— <br />Ground El El Chocolate <br />c) c) <br />l <br /> <br />Fried or Baked <br />Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />CI Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 <br /> CFO FtEG/PEFtMITTING FORM <br />Pk15 otn21