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A-0 2, 25 <br /> SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> «-. { 1868 East Hazelton Avenue, Stockton, CA 95205-6232 e e A <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.smgov.org/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 /> PALMYBA SWEET a,;ha Rarmada 20/1/2025 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 772 West Anti_qua Terr Mountain House 95391 <br /> Website(If applicable): Telephone: <br /> (925)895-4392 <br /> 1. Categories: <br /> ❑ "Class A" (Direct Sales Only) $186 ® "Class B" (Direct & Indirect Sales) $486 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: RB <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 /> 3. "Class A" Self Certification Checklist: <br /> ❑ Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> ❑ Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter— <br /> El Buttercream Ground <br /> ❑ Frosting/Icing" Fonda nt/Gumpaste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies*" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> EH 16-276/29M23 1 CFO REGIPERMITTING FORM <br /> W2!5ws�-o <br /> s <br />