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eto 'I 0)/2/20 /v 2 S-0/4, <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: vvww.sioov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: Date: <br />Scrump Candy Co Allison Fedor Feb 6, 2025 <br />CFO Physical Address: CFO City: CFO Zip: <br />15817 E. Eugenia Ave. Ripon, CA 95366 <br />Website (If applicable): Telephone: 707-354-8831 <br />Categories: <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />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 A L ED. <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 />"Class A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Popcorn/ <br />Popcorn Balls <br />)gc...Candy 1=I Dry Baking Mixes 0 Mustard 0 Vinegar <br />0 Churros El Waffle Cones III Dried Grain Mixes LI Fruit Butter** <br />El Buttercream 0 Buttercream <br />Frosting/Icing* Fondant/Gumpaste" III Flat Ici Ground ng 0 Chocolate <br />El Dried Mole Paste III Herb/Spice Blends lIl Pizzeles 111 Jams/Jellies** <br />Fried or Baked <br />El Fruit Empanadas LI Fruit Tamales/Pies LI Nut Mixes/Nut LI Butters Donuts and <br />Waffles <br />LI Granola/Cereals LI Seasoning Salt 0 Trail Mix/ Dried Fruit El Dried Fruit <br />Marshmallows/ <br />0 Cotton Candy ill Candied Apples El Salted LI Caramel/Fudge Marshmallow <br />Bars* <br />EH D 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />LI Baked Goods D Dried Pasta LI Honey LI <br />KS <br />PRO59 S35