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SANdOAQUIN Environmental Health Department <br />h'Ae.':'—COUNTY— <br />��;;.� Grenlnpzs 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: Dale <br />Dulcenea's Cakes and Bakes By Candy Albor Candy Albor 1/30/2023 <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: �2/ <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. <br />"Class A" Self Certification Checklist: <br />V Checklist completed <br />("Class A" CFOs Only) <br />4. <br />Products: <br />Please check the Items you will be preparing and/or selling. <br />91 <br />Baked Goods <br />E]Dried <br />Pasta <br />❑ <br />Honey <br />❑ <br />Popcorn/ <br />Popcorn Balls <br />❑ <br />Candy <br />V <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter** <br />Buttercream <br />Buttercream <br />4a <br />Flat Icing <br />v <br />Ground <br />Frosting/Icing` <br />Fondant/Gumpaste" <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies'" <br />Fried or Baked <br />F-1 <br />FruitEmpanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />gutters <br />E] <br />Donuts and <br />Waffles <br />❑ <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />Marshmallows/ <br />El <br />Cotton Candy <br />❑ <br />Candied Apples <br />Salted <br />Caramel/Fudge <br />Marshmallow <br />Bars <br />❑ <br />Dried or Dehydrated <br />❑ <br />Dried Vegetarian- <br />❑ <br />Vegetable and Potato Chips <br />Vegetables <br />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 />