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1. Categories: <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[3 Dried Pasta HoneyBaked Goods <br />□ Vinegar[3 Dry Baking Mixes MustardCandy <br />□ Waffle Cones□Dried Grain MixesChurros <br />□□□□Flat Icing <br />KI Jams/Jellies**□I3 Herb/Spice Blends□PizzelesDried Mole Paste <br />□ Fruit Tamales/Pies□Fruit Empanadas <br />Trail Mix/Dried Fruit 0 Dried Fruit0 Seasoning SaltGranola/Cereals <br />□ Candied Apples□Cotton Candy <br />CFO REG/PERMITTING FORM1EHD 16-27 6/29/2023 <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <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 />Initial if you agree to abide by the following: LF <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 />Fried or Baked <br />□ Donuts and <br />Waffles <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />3. “Class A” Self Certification Checklist: <br />53 Checklist completed (“Class A” CFOs Only) <br />Da,e 22.1 ZoZ-S <br />CFO Physical Address: CFO City: <br />Website (If applicable): Telephone: <br />[3 Fruit Butter** <br />CFOZip:C\5222 <br />°“e:UW(ACFO Business Name: i \ v— <br />LoCcA Vox