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V\cVof\g< Scott <br />c-v <br />1. Categories: <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 />□□□Baked Goods Dried Pasta Honey <br />□□□□ VinegarCandyDry Baking Mixes Mustard <br />□□□□ Fruit Butter**Churros Waffle Cones Dried Grain Mixes <br />□□□□Flat Icing <br />□□□□ Jams/Jellies**Dried Mole Paste Herb/Spice Blends Pizzeles <br />Fruit Tamales/Pies□□Fruit Empanadas <br />□□ Seasoning Salt □□ Dried FruitGranola/Cereals Trail Mix/ Dried Fruit <br />□0 Candied Apples □Cotton Candy <br />iEHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Popcorn/ <br />Popcorn Balls <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 />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />3. “Class A” Self Certification Checklist: <br />ES^hecklist completed ("Class A" CFOs Only) <br />Date: <br />CFO Zip: <br />3^ |_______ <br />Owner Name <br />CFO Physical Address: CFO City <br />~1\ • fe\.v\. ^Vinson C-V <br />Website (If applicable): Telephone: <br />______'Z.pq ■ ■ ooAo <br />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 />CEO Business Name