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SAN DAQUIN Environmental Health Department <br /> COUNTY-- <br /> Grcutness gro, �c luvi,. <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br /> CFO Business Name: Owner Name: Dale: <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 Tract/ CA 95376 <br /> Website(If applicable): Telephone: <br /> 209-597-2249 <br /> 1. Categories: <br /> V "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales) $310 ,, <br /> 2. Prohibited Items: Initial if you agree to abide by the following: C� <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 /> V Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will he preparing and/or selling. <br /> r Popcorn/ <br /> yf Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn Balls <br /> ❑ Candy Dry Baking Mixes ❑ Mustard [I vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream iz Buttercream lZ Flat Icing Ground <br /> Frosting/Icing' Fondant/Gumpaste' Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies" <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ gutters E] 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 m Marshmallow <br /> Bars' <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue l Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />