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P 2Lo0o252 <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 s ov or lEHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name nsTastybyG011,11 Owner Name' 0ohar Abid Date w K,!yf,r <br /> CFO Physical Address 346 N Alia Pena st CFO City Trary CFO 71p <br /> Website(i(apphoable) Telephone: <br /> shop.itstastybygoh ar.com <br /> 1. Categories: <br /> ❑ "Class A' (Direct Sales Only) $186 M "Class B° (Direct& Indirect Sales) $486 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: GA <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 /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class A' CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ❑ Baked Goods F1Dried Pasta E] Honey El Popcorn/ <br /> Balls <br /> ❑ Candy ® Dry Baiting Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones (x] Dried Grain Mixes ❑ Fruit Butter" <br /> ❑ ButtercreamElButtercream [] Flat Icing ❑ Ground <br /> Frosting/Icing' FondantlGumpaste" Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies"" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ <br /> Granola/Cereals ® Seasoning Salt ❑ Trail Mix/ Dried Fruit ® Dried Fruit <br /> Marshmallows/ <br /> ElCotton Candy ❑ Candied Apples ❑ Salted ❑ Marshmallow <br /> Caramel/Fudge Bars" <br /> EHE 16.276!29/2023 I CFO RE&PERMITTING FORM <br /> C <br />