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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-| Popcorn/□ Dried Pasta □ HoneyBaked Goods Popcorn Balls <br />Candy 0 Dry Baking Mixes □□ VinegarMustard <br />-0 Waffle Cones□□ Dried Grain MixesChurros <br />□ Flat Icing□□□ <br />□0 Herb/Spice Blends 0 Pizzeles 0 Jams/Jellies**Dried Mole Paste <br />□0 Fruit Tamales/Pies 0Fruit Empanadas <br />0 0 Seasoning SaltGranola/Cereals <br />o 0 Candied ApplesCotton Candy <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Ground <br />Chocolate <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: www.siqov.orq/EHD <br />p <br />1. Categories: <br />"Class A” (Direct Sales Only) $186 <br />C,vro Zip: <br />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 />Fried or Baked <br />0 Donuts and <br />Waffles <br />CFO Business Name: <br />CFO Physical Address: <br />Website (If applicable): <br />3. “Class A” Self Certification Checklist: <br />^0 Checklist completed (“Class A" CFOs Only) <br />0 Trail Mix/ Dried Fruit 0 Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />0 Fruit Butter** <br />Owner Name: C <br />CFO City: <br />Telephone: