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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />ii0M-Matte Love Utea. Peru <br />CFO Physical Address: CFO City: <br /> <br />Date: ifst <br />CFO Zip: <br /> <br />k13c1 B-erl -eeti ck 1)r, WOOSioridele, ci525e, <br />Website (If applicable): Telephone: <br />‘2_oe1 -482- <br />Categories: <br />TX "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 />RECEIVED <br />"Class A" Self Certification Checklist: <br />p(Checklist completed ("Class A" CFOs Only) APR 18 2024 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />Please check the items you will be preparing and/or selling. <br />LI <br />El <br />El <br />El <br />0 <br />0 <br />0 <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Fresting/lcing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />El <br />El <br />El <br />El <br />CI <br />0 <br />El <br />0 <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />CI <br />0 <br />El <br />El <br />El <br />El <br />0 <br />ri <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 />Popcorn/ El Popcorn Balls <br />El Vinegar <br />0 Fruit Butter** <br />Ground El Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />El Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />Products: <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM