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Foopj <br />Telephone: <br />C4oO ^4'0^13 <br />□“Class A” (Direct Sales Only) $186 “Class B” (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□ Dried Pasta □ Honey □Baked Goods <br />KI K) Dry Baking Mixes □ MustardCandy <br />□ Dried Grain Mixes □ Fruit Butter**□□ Waffle ConesChurros <br />J3 El Flat Icing □ <br />KI Pizzeles □ Jams/Jellies**El Herb/Spice BlendsDried Mole Paste <br />H Fruit Tamales/Pies □Fruit Empanadas <br />□ Dried Fruit□ Seasoning Salt □ Trail Mix/ Dried Fruit□Granola/Cereals <br />□□ Candied ApplesCotton Candy <br />1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />Buttercream <br />Frosting/lcing* <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Ground <br />Chocolate <br />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.siqov.org/EHD <br />Owner Name: <br />OSH 6 SLUYT <br />CFO City: <br />'TR.ACY <br />Date: . <br />CFO Zip: <br />Popcorn/ <br />Popcorn Balls <br />□ Vinegar <br />Initial if you agree to abide by the following: B • <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 />s >2- 2-5 <br />^2SDi)US4- <br />Fried or Baked <br />K Donuts and <br />Waffles <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />1. Categories: <br />K) <br />3. “Class A” Self Certification Checklist: <br />KI Checklist completed (“Class A" CFOs Only) <br />CFO Business Name: <br />Su^Hi Hoi^e <br />CFO Physical Address: <br />Website (If applicable):