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□“Class B” (Direct & Indirect Sales) S486 <br />3. “Class A” Self Certification Checklist: <br />□ Checklist completed (“Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Dried Pasta$Baked Goods Honeyr <br />Dry Baking Mixes Mustard Vinegar <br />Churros Waffle Cones Dried Grain Mixes Fruit Butter**I ■ <br />&Flat Icing <br />□Dried Mole Paste Herb/Spice Blends Pizzeles <br />Fruit Empanadas Fruit Tamales/Pies <br />, Seasoning Salt v Trail Mix/Dried Fruit t Dried FruitGranola/Cereals <br />0[yi Candied ApplesCotton Candy <br />1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Ground <br />■ Chocolate <br />Marshmallows/ <br />, Marshmallow <br />Bars* <br />Fried or Baked <br />Donuts and <br />Waffles <br />Popcorn/ <br />Popcorn Balls <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <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 />1. Categories: <br />“Class A” (Direct Sales Only) $186 <br />CFO Business Name:fems1 <br />CFO Physical Address: <br />Website (If applicable): <br />Candy <br />K <br />Date- <br />CFO Zip: <br />Jams/Jellies** <br />Owner Name: -7—Oarmea/ /few <br />CFO City: <br />Telephone: <br />6 r 3: <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.