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/'ra* <br />6^6 <br />□“Class B” (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□□ Dried Pasta □□HoneyBaked Goods <br />□□ Vinegar0 Dry Baking Mixes□MustardCandy <br />□□ Waffle Cones□Dried Grain MixesChurros <br />□□□□Flat Icing <br />□ Jams/Jellies'□□PizzelesDried Mole Paste <br />□0 Fruit Tamales/Pies0Fruit Empanadas <br />Trail Mix/ Dried Fruit 0 Dried Fruit00 Seasoning Salt0Granola/Cereals <br />□0 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 />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />Ground <br />Chocolate <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 />1. Categories: <br />“Class A" (Direct Sales Only) $186 <br />Buttercream <br />Fondant/Gumpaste* <br />X? Herb/Spice Blends <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 />Fried or Baked <br />0 Donuts and <br />Waffles <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />CFO Business Name: <br />Asp. <br />CFO Physical Address: <br />■^-3 e c\^ 5^ <br />Website (If applicable): <br />3. “Class A” Self Certification Checklist: <br />Checklist completed (“Class A” CFOs Only) <br />0 Fruit Butter** <br />Date: <br />CFO Zip: <br />'2-0(2? <br />Owner Name^ <br />CFO City: <br />5 Yog kao tZ\ C A- <br />Telephone: