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3S'7S' <br />□ “Class B' (Direct & Indirect Sales) S486 <br />□□ Dried Pasta Honey□Baked Goods <br />□Mustard□ Dry Baking Mixes□Candy <br />□ Fruit Butter**□Dried Grain Mixes□ Waffle Cones□Churros <br />□□Flat Icing□□ <br />□Pizzeles□ Herb/Spice Blends□Dried Mole Paste <br />□□ Fruit Tamales/Pies□Fruit Empanadas <br />□ Dried Fruit□Trail Mix/ Dried Fruit□ Seasoning Sall□Granola/Cereals <br />□□ Candied Apples□Cotton Candy <br />CFO REG/PERMITTING FORM1EHD 16-27 6'29/2023 <br />I <br />I <br />I <br />I <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gurnpaste* <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.siaov.org/EHD <br />Date <br />CFO Zip <br />Popcorn/ <br />Popcorn Balls <br />□ Vinegar <br />Fried or Baked <br />□ Donuts and <br />Waffles <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />3. “Class A” Self Certification Checklist: <br />53 Checklist completed (“Class A" CFOs Only) <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 />Ov/ner Name <br />Koy trile <br />CFO City ' <br />Telephone <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-bome illness. <br />CFO Business Name. <br />tioyz y Fa S <br />CFO Physical Address <br />Webs'te (If applicable) <br />------------------------------- <br />1. Categories: <br />® “Class A" (Direct Sales Only) S186 <br />□ Jams/Jellies** <br />4. Products: <br />Please check the items you will be preparing and/or selling.