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Made with Xodo PDF Reader and Editor <br />□ ' Class B" (Direct & Indirect Sales) $486 <br />&&Honey □Dried PastaBaked Goods <br />&MustardDry Baking MixesCandy <br />□ Fruit Butter**□Churros <br />0 Flat Icing □ <br />[X Jams/Jellies”□ PizzelesHerb/Spice Blends□Dried Mole Paste <br />Fruit Tamales/Pies□Fruit Empanadas <br />|X] Trail Mix/ Dried Fruit10PQ Seasoning Salt Dried FruitGranola/Cereals <br />a□ Candied ApplesCotton Candy <br />t CFO REdPERMITTiNG FORM6/^073 <br />250031^ <br />Buttercream <br />Frosting/lcing* <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Ground <br />Chocolate <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Popcorn/ <br />Popcorn Balls <br />PQ Vinegarsi <br />Dried Grain Mixes□ Waffle Cones <br />CFO Zip: <br />1. Categories: <br />“Class A" (Direct Sales Only) $186 <br />3. “Class A" Self Certification Checklist: <br />^ ..Checklist completed (“Class A" CFOs Only) <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: w\w/.sjgov,orci/.EHD <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 />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 />Owner Name <br />TtcaCa Jo <br />CFO City: <br />fWMrca.________ <br />Telephone: <br />CFO Business Nwne j <br />CFO Physical Adjjmss *—> <br />Website (If applicable) <br />Marshmallows,'' <br />KI Marshmallow <br />Bars* <br />Fried or Baked <br />[X Donuts and <br />Waffles <br />4. Products: <br />Please check the items you will be preparing and/or selling.