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Af <br />19256059585n/a <br />□“Class B" (Direct & Indirect Sales) S486 <br />4. Products: <br />Please check the items you will be preparing and/or selling <br />□ Dried Pasta □ Honey □Baked Goods <br />□ Dry Baking Mixes □ Mustard□□ VinegarCandy <br />□ Waffle Cones □ Dried Gram Mixes□□ Fruit Butter’*Churros <br />0 Flat Icing <br />0 Herb/Spice Blends 0 Pizzeles□□ Jams/Jellies’*Dried Mole Paste <br />0 Fruit Tamales/Pies □□Fruit Empanadas <br />0 Seasoning Salt □ Trail Mix/Dried Fruit□0 Dried FruitGranola/Cereals <br />0 Candied Apples □□Cotton Candy <br />EHD 16 27 6/26/2023 1 CFO REGPERMIT TING FORM <br />5P^OOL-lSfl <br />Ur, — <br />Buttercream <br />Frostmg/lcing* <br />Buttercream <br />Fondant/Gumpaste" <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Ground <br />Chocolate <br />Popcorn/ <br />Popcorn Balls <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <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: wwyASjgov.or.q/EHD <br />0 <br />0 <br />00 <br />1. Categories: <br />0 “Class A" (Direct Sales Only) $186 <br />CFO Business Name <br />Oma s Cottage <br />CFO Physical Address <br />984 Shelborne Dr <br />Website (If applicable) <br />Owner Name <br />Christel Gampig-Avila <br />CFO City <br />Tracy <br />Telephone <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />Fried or Baked <br />□ Donuts and <br />Waffles <br />3. “Class A” Self Certification Checklist: <br />0 Checklist completed ("Class A" CFOs Only) <br />Date <br />July 14, 2026 <br />CFO Zip <br />95377 <br />Pis. <br />2. Prohibited Items: Initial if you agree to abide by the following: CGA <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