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CFO Business Name: <br />Website (If applicable): <br />□ “Class B" (Direct & Indirect Sales) $486“Class A” (Direct Sales Only) $186 <br />2. Prohibited Items: <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />0 Dried Pasta □ Honey □3 Baked Goods <br />□□ Dry Baking Mixes □ Mustard 0 VinegarCandy <br />o 0 Waffle Cones 0 Dried Grain Mixes 0 Fruit ButterChurros <br />s-[3 Flat Icing 0 <br />0 Pizzeles 0 Jams/Jellies:□0 Herb/Spice BlendsDried Mole Paste <br />0□0 Fruit Tamales/PiesFruit Empanadas <br />0 Trail Mix/Dried Fruit 0 Dried Fruit0 Seasoning Salt0Granola/Cereals <br />0 Candied Apples0Cotton Candy <br />1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />1 <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Ground <br />Chocolate <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 />CFO-City: <br />Manteca <br />Owner Name: <br />Yssur Hammdan Date: <br />09\25\2025 <br />[*] <br />CFO Zip: <br />95336 <br />Rise Up <br />CFO Physical Address: <br />941 Nordic Place <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />1. Categories: <br />3 <br />3. “Class A” Self Certification Checklist: <br />3 Checklist completed ("Class A” CFOs Only) <br />A- /*• r-e’-i ■ <br />Initial if you agree to abide by the following: YH <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 />Telephone: 41553g81l0