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1. Categories: <br />□"Class A" (Direct Sales Only) $186 "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />RECEIVED <br />lass A” Self Certification Checklist: <br />APR 1 8 202'tChecklist completed (“Class A” CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□□□□Baked Goods HoneyDried Pasta <br />□ Vinegar□□□Candy Dry Baking Mixes Mustard <br />□ Fruit Butter'□□□Churros Waffle Cones Dried Grain Mixes <br />□□ □ <br />Flat Icing <br />□ Jams/Jellies□□Dried Mole Paste Herb/Spice Blends <br />□□□Fruit Tamales/PiesFruit Empanadas <br />□□□□Dried FruitTrail Mix/ Dried FruitGranola/Cereals Seasoning Salt <br />□□□□Cotton Candy Candied Apples <br />CFO REG/PERMITTING FORM1EHD 16-27 6/29/2023 <br />1 <br />pp. <br />Buttercream <br />Frosting/lcing* <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Buttercream <br />Fondant/Gumpaste" <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />^Fried or Baked <br />Donuts and <br />Waffles <br />Ground <br />Chocolate <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />Popcorn/ <br />Popcorn Balls <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-01 38 Web: www.siciov.org/EHD <br />CFO Business Name: ■ • t Owner Name: <br />ipyjs X] i an Njoku-Oparo, <br />CFO Physical Address: CFO City: <br />Big ftear DnV'e/LaThrc>p,Cfl <br />Website (If applicable): Telephone: <br />5l0)33)-?354 <br />□ <br />KJ Pizzeles <br />Initial if you agree to abide by the following: <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 />tr • I <br />Date: . <br />CFO Zip: