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Oct. 22, 2024Owner Name: Chua Lo-Yang <br />CFO Zip:95212StocktonCFO City:CFO Physical Address: q 0673 Allman Dr <br />Telephone. 828-404-6481Website (If applicable): <br />"Class B” (Direct & Indirect Sales) $486“Class A" (Direct Sales Only) $186 <br />CL <br />2. Prohibited Items: <br /> Honey Dried Pasta0Baked Goods <br /> Vinegar Mustard Dry Baking Mixes0Candy <br /> Fruit Butter** Dried Grain Mixes Waffle ConesChurros <br /> Flat IcingE <br /> Pizzeles Herb/Spice BlendsDried Mole Paste <br />[KI Fruit Tamales/PiesFruit Empanadas <br /> Seasoning SaltGranola/Cereals <br /> Candied Apples0 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 />3. “Class A” Self Certification Checklist: <br />[X] Checklist completed ("Class A” CFOs Only) <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />1. Categories: <br />E <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 />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />L ‘■”'^€^<SALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />.. . .. Dumor Namp- Phi ia I n-Vann Date. <br /> Trail Mix/ Dried Fruit Dried Fruit <br />Marshmallows/ <br />{Xl Marshmallow <br />Bars* <br /> Jams/Jellies** <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWECr <br />Only foods that are defined as “non-potentially hazardous" are approved for preparation by rbacterial <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 />VName chua Lo’Yan9