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• <br />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.siqov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Nam Owner Name: <br />'101A"Vil VCISki" En-€J1c)-A18e) <br />CFO Physical Address: CFO City: <br />\C1E1 CUtSbicAll cLoc,471 s14oaNA CA- c/0(42 <br />Website (If applicable): TelepAione: <br />\cr\ c5,(Y\ t-4AU 5 roak--V - Cdovvl <br />1. 5ateciories: <br />"Class A" (Direct Sales Only) $186 <br />Dateq9. <br />CFO Zip: / <br />Eao) cisq --tqs-s <br />El "Class B" (Direct & Indirect Sales) $486 <br />Prohibited Items: LInitial if you agree to abide by the following: 'L <br /> <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 />III Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Ple se check the items you will be preparing and/or selling. /Zked Goods 0 Dried Pasta <br />andy EZiry Baking Mixes <br />El Churros <br />R/Buttercream <br />Frosting/Icing* <br />0 Dried Mole Paste <br />0 Fruit Empanadas <br />0 Granola/Cereals <br />El Cotton Candy <br />0 <br />0 <br />0 <br />0 <br />0 <br />El <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />Fruit Tamales/Pies <br />Seasoning Salt <br />Candied Apples <br />1=I <br />El <br />0 <br />0I <br />El <br />El <br />El <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 <br />0 <br />0 <br />0 <br />El <br />El <br />0 <br />El <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Fruit Butter** <br />Ground <br />Chocolate <br />Jams/Jellies** <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />EHD 16-27 6/29/2023 1 CFO REG/PERMITTING FORM