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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.orq/EHD <br />&c IvI4r <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM JUN <br />2024 (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO))sAtilvJo4Qui <br />HE'AL*2Nitie9UN <br />CFO Business Name: Owner Name: Date: EPA R-7-411.4Z-Nr <br />THE SOWN SEED SOURDOUGH CYNDI VELASCO <br />CFO Physical Address: CFO City: CFO Zip: <br />986 JORDANOLO DRIVE <br /> RIPON <br /> 95366 <br />Website (If applicable): <br /> <br />Telephone: <br />925-765-3350 <br />clrac,v e,61,Sce(044Antex- <br />. Categories: <br /> <br />"Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: Initial if you agree to abide by the following: cv <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: RECEIVED <br /> <br /> <br />46 <br />El <br />LI <br />El <br />D <br />LI <br />0 <br />Checklist completed <br />Products: <br />("Class A" CFOs Only) <br />you will be preparing and/or selling. <br />fl Dried Pasta El <br />'Dry Baking Mixes 0 <br />0 Waffle Cones D <br />Buttercream LI Fondant/Gumpaste* 1=1 <br />12r Herb/Spice Blends LI <br />LI Fruit Tamales/Pies LI <br />El Seasoning Salt LI <br />LI Candied Apples n <br />JUN 1 0 2024 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Popcorn/ Honey LI Popcorn Balls <br />Mustard 0 Vinegar <br />Dried Grain Mixes CI Fruit Butter** <br />Ground Flat Icing LI Chocolate <br />Pizzeles LI Jams/Jellies** <br />Fried or Baked Nut Mixes/Nut <br />Butters LI Donuts and <br />Waffles <br />Trail Mix/ Dried Fruit LI Dried Fruit <br />Marshmallows/ Salted Marshmallow Caramel/Fudge LI <br />Bars* <br />Please check the items <br />Baked Goods <br />Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />Cotton Candy <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />5/23/2024 <br />V Verlibkd by petlilller <br />05/23/2024