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CFO Business Name: kko'e AI □“Class A" (Direct Sales Only) $186 “Class B" (Direct & Indirect Sales) $486 2. Prohibited Items: 4. Products: Please check the items you will be preparing and/or selling. □□ Dried Pasta □ HoneyBaked Goods □ Mustard □ Vinegar□□ Dry Baking MixesCandy □ Dried Grain Mixes □ Fruit Butter**□ Waffle Cones□Churros □ Flat Icing □□□ □□ Jams/Jellies**□ Herb/Spice Blends□PizzelesDried Mole Paste □□ Fruit Tamales/Pies□Fruit Empanadas □ Trail Mix/ Dried Fruit □ Dried Fruit□ Seasoning Salt□Granola/Cereals □□ Candied Apples□Cotton Candy 1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 P^.25 00^ (FF Buttercream Frosting/lcing* San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/EHD Buttercream Fondant/Gumpaste* Nut Mixes/Nut Butters Salted Caramel/Fudge Popcorn/ Popcorn Balls Ground Chocolate COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) CFO Physical Address: Website (If applicable): Owner Name: CFO City: Telephone: Date: CFO Zip: Fried or Baked □ Donuts and Waffles Marshmallows/ □ Marshmallow Bars* 1. Categories: 3//V25 3. “Class A” Self Certification Checklist: |\] Checklist completed (“Class A" CFOs Only) Initial if you agree to abide by the following: P- Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness.