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Website (If applicable): <br />1. Categories: <br />"Class A” (Direct Sales Only) $186 □“Class B" (Direct & Indirect Sales) $4860 <br />2. Prohibited Items:Initial if you agree to abide by the following: AP <br />“Class A” Self Certification Checklist:3 <br />0 Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□Honey □□Dried Pasta0Baked Goods <br />□□ VinegarDry Baking Mixes Mustard□□Candy <br />□Fruit Butter**□Dried Grain Mixes□Waffle Cones□Churros <br />□□Flat Icing□□ <br />□Jams/Jellies**Herb/Spice Blends □Pizzeles□□Dried Mole Paste <br />□Fruit Tamales/Pies□□Fruit Empanadas <br />□Dried FruitSeasoning Salt □Trail Mix/ Dried Fruit□□Granola/Cereals <br />□□Candied Apples□□Cotton Candy <br />1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />CFO Business Name: <br />Namma Ooru Kadai <br />CFO Physical Address: <br />1702 Stephanie St <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Owner Name: <br />Adhithi Prabhuraj <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />Ground <br />Chocolate <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Telephone: <br />4694071421 <br />CFO City: <br />Manteca <br />CFO Zip: <br />95337 <br />Date: <br />12/19/2025 <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />0l|3'o|2£ . <br />San Joaquin County <br />Environmental Health Department <br />1668 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Tetephone: (209) 468-3420 Fax: (209} 464-0138 Web: HYPERLINK <br />TiUp:I'Avrt-w. sjgcv.orgi'EHD" www.sjgov.org/EHD <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.