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Nut Mixes/Nut <br />Butters El <br />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.sjqov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />JUN ev 0 6 2024 ftilliblvio47-4c <br />CF Business Name: <br />\c)cpc-A, <br />CFO Physical Address: <br />Website (If applicable): <br />Categories: <br />.2r--"Class A" (Direct Sales Only) $186 <br />Prohibited Items: <br />\I\A--Qe_SA <br />Telephone: <br />Do <br />Owner Name: <br />RQC:r R\\ \ IF <br />CFO C <br />Date: <br />CFO Zip: <br />C1S.U? <br />LI "Class B" (Direct & Indirect Sales) $486 <br />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 />"Cl ss A" Self Certification Checklist: <br />Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Candy <br />El Churros <br />jz- Buttercream <br />Frosting/Icing* <br />1:1 Dried Mole Paste <br />Ei Fruit Empanadas <br />El Granola/Cereals <br />El Cotton Candy <br />El Dry Baking Mixes <br />El Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />LI Herb/Spice Blends <br />El Fruit Tamales/Pies <br />E] Seasoning Salt <br /> <br />El <br />EJ Candied Apples El <br />LI Popcorn/ <br />Popcorn Balls <br />ID Vinegar <br />Mixes El Fruit Butter** <br />LI Ground <br />Chocolate <br />1:1 Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />Trail Mix/ Dried Fruit Ej Dried Fruit <br />Marshmallows/ Salted <br />Caramel/Fudge <br /> LI Marshmallow <br />Bars* <br />LI <br />.12K Baked Goods <br /> 0 Dried Pasta El Honey <br />Ei Mustard <br />D Dried Grain <br />LI Flat Icing <br />LI Pizzeles <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM