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^ZbO ^01 <br />Date: <br />Ml <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />□□□ Dried Pasta HoneyBaked Goods <br />□ Vinegar□□ Dry Baking Mixes □MustardCandy <br />□□ Fruit Butter”□O Waffle Cones Dried Grain MixesChurros <br />□□□□Flat Icing <br />□□ Jams/Jellies”□□ Herb/Spice Blends PizzelesDried Mole Paste <br />□□□ Fruit Tamales/PiesFruit Empanadas <br />□□ Dried Fruit□□ Seasoning Salt Trail Mix/ Dried FruitGranda/Cereals <br />□ Candied Apples □□Cotton Candy <br />CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />Buttercream <br />Frosti ng/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mixes/Nut <br />Butters <br />Popcorn/ <br />Popcorn Balls <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.orq/EHD <br />Salted <br />Caramel/Fudge <br />1. Categories: <br />0^ -Class A" (Direct Sales Only) $186 <br />Fried or Baked <br />□ Donuts and <br />Waffles <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />2. Prohibited Items: Initial if you agree to abide by the following: <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 />[B^Checklist completed (“Class A" CFOs Only) <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />, (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Vc\vJ \ S <br />C£O Business Name <br />Pay vs, bate. <br />CFO Physical Address <br />'N _ <br />Website (If applicable): <br />Owner Name: <br />Ochoa <br />CFO City: <br />Telephone: <br />70 <br />CFO Zip: <br />°IS5K <br />UcA) ■ 212s <br />C ' OsocAxO \ <br />□ "Class B" (Direct & Indirect Sales) $486