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Arf 2(oOZ°l^H <br />CFO Business Name:Owner Name:Date: <br />□“Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />Q^Honey(XU/Baked Goods □ Dried Pasta □ <br />Candy O^Dry Baking Mixes □ Mustard <br />EL/ Churros □ Waffle Cones □ Dried Grain Mixes <br />B'Alat Icing □ <br />□□Dried Mole Paste Pizzeles <br />(TJX Fruit Empanadas □ Fruit Tamales/Pies □ <br />□EJ-'-'^easoning Salt □Trail Mix/ Dried Fruit [LJ/5ried FruitGranola/Cereals <br />□□ Candied ApplesCotton Candy <br />1EHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />Buttercream <br />Frosting/lcing* <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />H-p/Buttercream <br />Fondant/Gumpaste* <br />[Q/Herb/Spice Blends <br />-Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Marshmallows/ <br />H-'fi/larshmallow <br />Bars* <br />Fried or Baked <br />Donuts and <br />Waffles <br />Popcorn/ <br />Popcorn Balls <br />□ Vinegar <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 />nee <br />Initial if you agree to abide by the following: S <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 />1. Categories: <br />EBk^Class A” (Direct Sales Only) $186 <br />Hj/Jams/Jellies** <br />[EPTruit Butter** <br />o i - (3, 2^ <br />CFO Zip: <br />5'^ - 3^7-0 377______ <br />3. “Class A” Self Certification Checklist: <br />□ Checklist completed ("Class A" CFOs Only) <br />CFO Physical Address: CFO City: <br />VT5o Ractlcike C. irrlg, <br />Website (If applicable): Telephone: