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11- <br />□□ Honey□ Dried Pasta <br />□ Mustard□ Dry Baking MixesCandy <br />□ Fruit Butter4*□ Dried Grain Mixes□ Waffle ConesChurros <br />□□ Flat Icing□□ <br />□ Pizzeles <br />□□ Fruit Tamales/PlesQ Fruit Empanadas <br />Seasoning Salt□ Granola/Cereals <br />□□ Candied Apples□ Cotton Candy <br />Cl O WG/PCHMmriNG fOHMiL HO 1,6-27 6/20/2023 <br />Salted <br />Caramel/Fudge <br />Nut Mlxes/Nut <br />Butters <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) 408-3420 Fax: (209) 464-0138 Web: wwanteY orfl/..EH2 <br />Dola. <br />CFO zip: <br />Buttercream <br />Frosting/lcing* <br />□ Dried Mole Paste <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Splce Blends <br />Popcorn/ <br />Popcorn Balls <br />□ Vinegar <br />Baked Goods <br />□ <br />CFO Business Name: <br />CFO Physical Address' . <br />173^7 Enkiyn^ K?/ <br />Website (If applicable): <br />Ma/tn. neT <br />1. Catogorios: <br />“Class AB (Direct Sales Only) $186 <br />Owner Name' . zj <br />CFO City: <br />Telephone <br />□ Jams/Jellles** <br />Fried or Baked <br />□ Donuts and <br />Waffles <br />gj Trail Mix/Dried Fruit $ Dried Fruit <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />3. “Class A” Self Certification Checklist <br />Checklist completed (“Class A” CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□ "Class B* (Direct & Indirect Sales) $486 . <br />2. prohibited Items: Initial If you agree to abide by the following: Cx--------- <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.