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DECEIVED <br />DEC 0 8 2025 <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 />□□□□Baked Goods Dried Pasta Honey <br />□□□□ VinegarCandyDry Baking Mixes Mustard <br />□□□□ Fruit Butter’Churros Waffle Cones Dried Grain Mixes <br />□□□□Flat Icing <br />□□□Dried Mole Paste Herb/Spice Blends Pizzeles <br />□□□Fruit Empanadas Fruit Tamales/Pies <br />□□□ Dried FruitTrail Mix/ Dried FruitGranola/Cereals Seasoning Salt <br />□□□Cotton Candy Candied Apples <br />iEHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />?R2.^CODU| <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Ground <br />Chocolate <br />Popcorn/ <br />Popcorn Balls <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, <br />Salted <br />Caramei/Fudge <br />Nut Mixes/Nut <br />Butters <br />1. Categories: <br />“Class A” (Direct Sales Only) $186 <br />Initial if you agree to abide by the followingzQrvZ „ <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-bome illness. <br />Fried or Baked <br />□ Donuts and <br />Waffles <br />Marshmallows/ <br />□ Marshmallow <br />Bars* <br />Date: <br />___lkZZiLZ2S_ <br />CFO Zip: <br />3. “Class A” Self Certification Checklist: <br />□ Checklist completed (“Class A” CFOs Only) <br />h b U i esudy nch <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)fNV^^^Jrvices <br />Owner Name: <br />Mo I be \ \inrk <br />CFO City: <br />t-OPI I CR <br />Telephone: <br />^.0^- 2.10-05 lQ <br />CFO Business tvlame: <br />CFO Physical Address: GranG/b. <br />MO 2. <br />Website (If applicable): <br />□ Jams/Jellies**