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1.7-Hou-2020 16:24 Private And Confidential. From:-2093679996 P.2 <br /> A U I N Environmental Health Department <br /> C(.D L <br /> r\J T Y, <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: omleEE}Na%el <br /> �, U-)RA ml <br /> CFO Physical Address: CI`6kity: CFO Zip: <br /> Website(11 applicable): Telephy e,." <br /> 2:1 . QVAe 1I <br /> 1. Categories: <br /> El "Class A"(Direct Sales Only)$155 10 -Class B"(Direct& Indirect Sales)$310 <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. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> n Checklist completed("Class KCFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling, <br /> Baked Goods 0 Dried Pasta El Honey El Popcorn/ <br /> Popcorn Balls <br /> Candy El Dry Baking Mixes El mustard El Vinegar <br /> rl Churros EI Waffle Cones Ej Dried Grain Mixes El Fruit Butter** <br /> Buttercream ElButtercream Ground <br /> Frostinglicing* Fondant/Gumpaste' Flat Icing A Chocolate <br /> E] Dried Mole Paste E) Herb/Spice Blends El Pi7zeles E] Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> D Fruit Empanadas ❑ Fruit Tamales/Pies ❑ 0 Donuts and <br /> Butters ❑ Waffles <br /> E] Granola/Cereals E] Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> . 1 Marshmallows/ <br /> El Cotton Candy El Candied Apples Salted <br /> Caramel/Fudge Marshmallow <br /> Bars* <br /> El Dried or Dehydrated 11 Dried Vegetarian- El Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 96205 T 209 468-34201 F 209 074-0138 1 www.sjgoV.org/EHU <br /> Received Time Nov. 17. 2020 3 : 19PM No- 6468 <br />