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Honey El Popcorn/ <br />Popcorn Balls <br />Mustard El Vinegar <br />El Dried Grain Mixes El Fruit Butter** <br />y Flat Icing El Ground <br />Chocolate <br />E Pizzeles El Jams/Jellies** <br />- •Ne"--• <br /> SAN JOAQUIN COUNTY <br />447-, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> <br />0:4 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: <br />l-tL Glcoci.s <br />CFO Physical Address: <br /> <br />Owner Name - <br />hex% i3etc4nct-x.Ark <br />Date: <br />2_5/1`A <br /> <br />CFO City: <br />tOCKW6 <br />CEO Zip: <br /> <br />Pivnixith Oaks Court <br /> <br />VVebsite (If applicable): <br /> <br />Telephone: <br /> <br />Categories: <br />2( "Class A" (Direct Sales Only) $186 "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 />"C ass A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing <br />I Baked Goods El Dried Pasta <br />E Candy <br />E Churros <br />Buttercream <br />Frosting/Icing* <br />CI Dried Mole Paste <br />and/or selling. <br />CI <br />E Dry Baking Mixes <br /> El <br />E Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />E Herb/Spice Blends <br />El <br />I=1 Fruit Empanadas E Fruit Tamales/Pies CI Nut Mixes/Nut <br />Butters <br />Fried or Baked <br />111 Donuts and <br />Waffles <br />El Seasoning Salt E Trail Mix/ Dried Fruit E Dried Fruit <br />El <br />E Granola/Cereals <br />I=1 Cotton Candy d Candied Apples Salted <br />Caramel/Fudge <br />/ Marshmallows/ <br />ler Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM