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Date:Owner Name: “Class B” (Direct & Indirect Sales) $486□ 2. Prohibited Items: 4. Products: Please check the items you will be preparing and/or selling. $□ Dried Pasta □ HoneyBaked Goods □□ Dry Baking Mixes □ VinegarCandyMustard □□ Waffle ConesChurros □□ Flat Icing □ >1 &□□ PizzelesDried Mole Paste Herb/Spice Blends □□ Fruit Tamales/Pies □Fruit Empanadas Seasoning Salt$□ Trail Mix/Dried Fruit □ Dried FruitGranola/Cereals □□ Candied Apples □Cotton Candy EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM Buttercream Frosting/lcing* Buttercream Fondant/Gumpaste* Salted Caramel/Fudge Nut Mixes/Nut Butters Ground Chocolate Popcorn/ Popcorn Balls COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) 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 CFO Zip: 95^ D 1. Categories: “Class A” (Direct Sales Only) $186 Fried or Baked □ Donuts and Waffles Marshmallows/ □ Marshmallow Bars* A* r.ta si sO. □ Dried Grain Mixes Jams/Jellies** 3. “Class A” Self Certification Checklist: □ Checklist completed (“Class A" CFOs Only) CFO Business Name: ( p. CFO Physical Address: Website (If applicable): Initial if you agree to abide by the following: 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. Fruit Butter** 5 CFO City: ColLi'eZ. tfd Telephone: