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s <br />Date: <br />□ “Class B" (Direct & Indirect Sales) $486 <br />£62. Prohibited Items: <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />SI □□ Dried Pasta HoneyBaked Goods <br />□□ Vinegar□ Dry Baking Mixes□MustardCandy <br />□ Fruit Butter**□□ Waffle Cones□Dried Grain MixesChurros <br />□□□□Flat Icing <br />□ Jams/Jellies**□□ Herb/Spice Blends□PizzelesDried Mole Paste <br />□□ Fruit Tamales/Pies□Fruit Empanadas <br />□ Dried Fruit□□ Seasoning Salt□Trail Mix/ Dried FruitGranola/Cereals <br />□□ Candied Apples□Cotton Candy <br />CFO REG/PERMITTING FORM1EHD 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 />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 />CFO Business Name: <br />Sbe Uav Made V)ccc<dlG <br />CFO Physical Address: <br />Website (If applicable): <br />CFO Zip: <br />Sf>Slmo <br />1. Categories: <br />"Class A” (Direct Sales Only) $186 <br />Owner Name: <br />Stdla Oli veifcx. <br />CFO City: <br />______________ <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. <br />Fried or Baked <br />□ Donuts and <br />Waffles <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />3. “Class A” Self Certification Checklist: <br />® Checklist completed (“Class A" CFOs Only)