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SAN JOAQUIN COUNTY <br /> «: :< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/EHD <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING FORM AN 10 <br /> sq ?OZy <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) N oqQu/N <br /> NEgL RpN CpV <br /> CFO Business Name: Owner Name: Date: ARTrgL <br /> THE SOWN SEED SOURDOUGH CYNDI VELASCO 5/23/2024 MFNT <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 986 JORDANOLO DRIVE RIPON 95366 <br /> Website(If applicable): Telephone: <br /> 925-765-3350 <br /> 1. Categories: r 1,61 <br /> Y W . fiVrr e <br /> 9Z "Class K(Direct Sales Only) $186 ❑ "Class B" (Direct& Indirect Sales)$486 <br /> ---------------- <br /> �. by,ffm.,; <br /> 2. Prohibited Items: Initial if you agree to abide by the following: C(/=- es„'„`=' <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 /> 3. "Class A" Self Certification Checklist: RECEIVED <br /> V1 Checklist completed ("Class A" CFOs Only) <br /> JUN 10 2024 <br /> 4. Products: <br /> ENVIRONMENTAL HEALTH <br /> Please check the items you will be preparing and/or selling. PERMIT/SERVICES <br /> Zj Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy [ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream Buttercream Ground <br /> Frosting/Icing* ElFondant/Gum paste* ❑ Flat Icing ❑ Chocolate <br /> ❑ Dried Mole Paste Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies"* <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM <br />