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SANJOAQUIN Environmental Health Department <br /> —COUNTY- <br /> - <br /> Greatness grows here. <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 /> Dulcenea's Cakes and Bakes By Candy Albor Candy Albor 01/06/2021 <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 1635 Court Drive Tracv CA 95376 <br /> Website(if applicable): Telephone: <br /> 209-597-2249 <br /> 1. Categories: <br /> Ij "Class A" (Direct Sales Only)$155 ❑ "Class B"(Direct&Indirect Sales)$310 n <br /> 2. Prohibited Items: Initial If you agree to abide by the following: (may <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 bacteria(growth that could be a <br /> cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> V Checklist completed ("Class A"CFOs Only) <br /> 4. Products: <br /> �rPlease check the items you will be preparing and/or selling. <br /> 1CI Baked Goods ElDried Pasta ElHoney ElPopcorn/ <br /> Popcorn Balls <br /> ❑ Candy V Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> ,IxButtercream Buttercream VFlat Icing Ground <br /> Frosting/Icing' Fondant/Gumpaste' Chocolate <br /> ❑ Dried Male Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ gutters El Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> El Cotton Candy El Candied Apples Caramel/Fudge Marshmallow <br /> Bars <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />