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SAN JOAQUIN COUNTY <br /> A <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95245-6232 <br /> p, R• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/EHD pa r <br /> REeF ANT <br /> COTTAGE FOOD OPERATIONS (CFO) F� <br /> REGISTRATION/PERMITTING FORM N J UN 1 p <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO))' N � o U,N ?OZ <br /> A�Ty D NIb1ENOVNr!' <br /> CFO Business Name: Owner Name: Date: Pgl�T Ak <br /> THE SOWN SEED SOURDOUGH CYNDI VELASCO 5/23/2024 MINT <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 986 JORDANOLO DRIVE RIPON 95366 <br /> Wehsite(If applicahle): Telephone: <br /> 925-765-3350 <br /> 1. Categories: <br /> 9Z "Class A" (Direct Sales Only) $186 ❑ "Class B" (Direct& Indirect Sales) $486 <br /> . V.rIfIM hY ptllFYlw <br /> 2. 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 /> 3. "Class A" Self Certification Checklist: RECEIVED <br /> Vj Checklist completed ("Class A" CFOs Only) <br /> JUN 10 202� <br /> 4. Products: <br /> ENVIRONMENTAL HEALTH <br /> Please check the items you will be preparing and/or selling. PERMIT!SERVICES <br /> 0 Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy 2/Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> Buttercream Buttercream El Ground <br /> Frosting/Icing' ❑ Fondant/Gumpaste` Flat Icing El Ground <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 6129I2O23 1 CFO REGIPERMITTING FORM <br /> �� ��0 I <br />