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9/22/2025CFO Business Name:Owner Name:Date: <br />CFO Physical Address:CFOjDIty:2409 California st CFO Zip:Escalon, ca 95320 <br />^W^Wtagram.com/oak.and.eWteourdough (209)923-0932 <br />“Class B" (Direct & Indirect Sales) $486 <br />LG <br />3. <br />s/ Baked Goods Dried Pasta W Honey <br />Candy Mustard <br />Churros Dried Grain Mixes <br /> Flat Icing <br />Dried Mole Paste Pizzeles <br /> Fruit Tamales/PiesFruit Empanadas <br />Granola/Cereals Seasoning Salt <br />Cotton Candy Candied Apples <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />Buttercream <br />Frosting/lcing* <br /> Dry Baking Mixes <br /> Waffle Cones <br />Salted <br />Caramel/Fudge <br />Nut Mixes/Nut <br />Butters <br />Ground <br />Chocolate <br />“Class A” Self Certification Checklist: <br />S' Checklist completed (“Class A” CFOs Only) <br />Buttercream <br />Fondant/Gumpaste* <br /> Herb/Spice Blends <br />Marshmallows/ <br /> Marshmallow <br />Bars* <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.org/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Oak + Ember OwnRrNamp. Lauren Gutierrez . <br />Sourdough <br />1. Categories: <br />^0 “Class A" (Direct Sales Only) $186 <br />Fried or Baked <br /> Donuts and <br />Waffles <br /> Trail Mix/Dried Fruit Dried Fruit <br /> Jams/Jellies** <br />Popcorn/ <br />Popcorn Balls <br /> Vinegar <br /> Fruit Butter** <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 />°P%t\??\TherjV00dS lnclude items that do not rec1u're refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness. <br />4. Products: <br />Please check the items you will be preparing and/or selling.