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1. Categories: □® “Class A” (Direct Sales Only) $ 186 “Class B” (Direct & Indirect Sales) $486 4. Products: Please check the items you will be preparing and/or selling. □□□ Dried Pastas HoneyBaked Goods □ Vinegar□□ Dry Baking Mixes□MustardCandy □ Fruit Butter**□□ Waffle Cones□Dried Grain MixesChurros □□□□Flat Icing □ Jams/Jellies'□□ Herb/Spice Blends□PizzelesDried Mole Paste □□ Fruit Tamales/Pies□Fruit Empanadas □ Dried Fruit□□ Seasoning Salt Trail Mix/ Dried Fruit□Granola/Cereals □□ Candied Apples□Cotton Candy CFO REG/PERMITTING FORM1EHD 16-27 6/29/2023 Buttercream Frosting/lcing* Buttercream Fondant/Gumpaste* Nut Mixes/Nut Butters Salted Caramel/Fudge Popcorn/ Popcorn Balls Ground Chocolate COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www siqov.orq/EHD Date: CFO Zip: Fried or Baked □ Donuts and Waffles Marshmallows/ □ Marshmallow Bars* 3. “Class A” Self Certification Checklist: O' Checklist completed (“Class A" CFOs Only) 2. Prohibited Items: Initial if you agree to abide by the following: kX Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as “non-potentially hazardous” are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness. CFO Business Name: MyAinc X- Co CFO Physical Address: GAIZI Pl Website (If applicable): v) y) . VyA Owner Name: ; CFO Cit): on Telephone: