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Website (If applicable): <br />1 Categories: <br />“Class A’ (Direct Sales Only) $186 “Class B* (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />“Class A” Self C3 <br />4 Products: <br />Please check the items you will be preparing and/or selling. <br />I HoneyBaked Goods Dried Pasta <br />Candy Dry Baking Mixes Mustard Vinegar <br />Churros Waffle Cones Dried Grain Mixes Fruit Butter— <br />Rat Icing <br />Dried Mole Paste HertVSpice Blends Pizzeles Jams/Jeflies— <br />Fruit Empanadas Fruit Tamales/Pies u u <br />Granola/Cereals Seasoning Salt Trafl Mix/Dried Fruit Dried Fruit <br />Cotton Candy Candied Applesu u u <br />EHOte-27W2W2023 1 Cf=O RE&PERMimNG FORM <br />Eliui <br />CFO Physical Address: <br />301 W Oak Street <br />CFO Business Name <br />Academia Apiary <br />Buttercream <br />Fondant/Gumpaste* <br />CFO City: <br />Lodi <br />Date: <br />1/1842026 <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />CFOZjp: <br />95240 <br />Ground <br />Chocolate <br />Fried or Baked <br />Donuts and <br />Vtfeiffles <br />Popcorn/ <br />Popcorn Balls <br />Sam Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue. Stockton. GA 85205-6232 <br />(200) 400-3420 Ftar.- (209) 404-0130 MM.* HYPERLINK <br />TTttp^A*wwjjQov.<xu/EHD" www^oov.om/EHD <br />Telephone: <br />(209) 200-2886 <br />Owner Name <br />Matthew Lewis <br />Buttercream <br />Frosting/ldng* <br />Initial if you agree to abide by the following:ML <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-bome illness. <br />cation Checklist: <br /> Checklist completed (“Class A“ CFOs Only)