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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 />□□□HoneyDried PastaBaked Goods <br />0 Vinegar□□□MustardDry Baking MixesCandy <br />□ Fruit Butter**□□□Dried Grain MixesWaffle ConesChurros <br />Flat Icing □ <br />□□ Herb/Spice Blends Jams/Jellies**□PizzelesDried Mole Paste <br />(j^^ruit Tamales/Pies □Fruit Empanadas <br />□ Dried Fruit□□ Seasoning Salt□Trail Mix/ Dried FruitGranola/Cereals <br />□□ Candied Apples□Cotton Candy <br />1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <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 />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />Ground <br />Chocolate <br />.Fried or Baked <br />Donuts and <br />Waffles <br />•Marshmallows/ <br />Marshmallow <br />Bars* <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 />Date: <br />CFO Zip:CFO Physical Address. <br />Dr <br />Website (If applicable): <br />3. “Class A” Self Certification Checklist: <br />[7] Checklist completed ("Class A" CFOs Only) <br />CFO Business Narne: Owner Name: / <br /><n Ol u z Ptokt-nd (ArV'l <br />CFO Physical Address', / ’ CFO Ctty: , I / <br />Cel___ <br />Telephone: <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.