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CFO Business Name:Date: <br />“Class A” (Direct Sales Only) $186 <br />Baked Goods □ Dried Pasta □ <br />□Candy □ Dry Baking Mixes □ Mustard <br />Churros □ Waffle Cones □Dried Grain Mixes <br />□□Flat Icing <br />□Dried Mole Paste □Pizzeles <br />□□Fruit Empanadas □ Fruit Tamales/Pies <br />□Granola/Cereals 0 Seasoning Salt □ Trail Mix/ Dried Fruit □ Dried Fruit <br />□□ Candied ApplesCotton Candy s <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />003(^| <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Fried or Baked <br />Donuts and <br />Waffles <br />Ground <br />Chocolate <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 />CFO PtiysicBl Address: <br />i-ViZ <br />Website (If applicable): <br />“Class B” (Direct & Indirect Sales) $486 <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />Popcorn/ <br />Popcorn Balls <br />□ Vinegar <br />1. Categories: <br />□ <br />□ <br />Herb/Spice Blends <br />3. “Class A” Self Certification Checklist: <br />□ Checklist completed (“Class A” CFOs Only) <br />CFO Zip: <br />□ Fruit Butter** <br />Owner Name: ( <br />l^0\G \-C kZ(TK?.<\' \ <br />CFO •City: T O <br />Telephone: <br />□ Jams/Jellies** <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 />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Honey <br />CFO •City: <br />4