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X:r Baked Goods <br />El Candy <br />El Churros <br />Buttercream <br />Frosting/Icing* <br />El Dried Mole Paste <br />0 Fruit Empanadas <br />El Granola/Cereals <br />El Cotton Candy <br />El <br />FRo9-1 86T-5 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HIazelton Avenue, S+Lockton, CA 95205-62'32 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.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 />Pc?-=1 7tie.aA (Arvial <br />CFO Physical Address: CFO City: _ CFO Zip: <br />CeeliA ciA.cr tAn7 <br />Website (If applicable): <br />TtePtZ; (1) V2-j7-3(D <br /> <br />Categories: <br />)21,7."Class A" (Direct Sales Only) $186 D "Class B" (Direct & Indirect Sales) $486 <br />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. <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 />"Class A" Self Certification Checklist: <br />0 Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />1 2- 2-1 22-2 <br />El <br />GI <br />El <br />El <br />D <br />D <br />D <br />D <br />Dried Pasta <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />El <br />0 <br />El <br />GI <br />El <br />El <br />0 <br />El <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />El Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />0 Fruit Butter** <br />El Ground <br />Chocolate <br />0 Jams/Jellies** <br />Fried or Baked <br />0 Donuts and <br />Waffles <br />GI Dried Fruit <br />Marshmallows <br />D Marsh mallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM