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Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />El Dried Mole Paste <br />Dry Baking Mixes <br />Waffle Cones <br />Buttercream <br />Fondant/Gumpaste" <br />1=1 Herb/Spice Blends <br />CI <br />CI Fruit Empanadas 1=1 Fruit Tamales/Pies <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.sigov.orq/EHD <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />'O n Le Live° n A cODVA-C Ve.M.k CIMA <br />CFO Physical Address: CFO City: <br />(f)W at MettetotA) Ts1•1)te-t-b °t'32-11 <br />Website (If applicable): Telephontl 0.) (DILI_ tyi <br />Categories: <br />1g( "Class A" (Direct Sales Only) $186 0 "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: \a/ <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 />X Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />Baked Goods 0 Dried Pasta Ei Honey Popcorn/ <br />Popcorn Balls <br />Date: <br />ti SI1U9A <br />CFO Zip: <br />Nut Mixes/Nut <br />Butters <br />111 Mustard <br />El Dried Grain <br />Flat Icing <br />El Pizzeles <br />CI <br />El Vinegar <br />Mixes 111 Fruit Butter** <br />CI Ground <br />Chocolate <br />CI Jams/Jellies*" <br />Fried or Baked <br />CI Donuts and <br />Waffles <br />El Granola/Cereals 0 Seasoning Salt 0 Trail Mix/ Dried Fruit 111 Dried Fruit <br />Cotton Candy CI Candied Apples El Salted <br />Caramel/Fudge <br />Marshmallows/ <br />El Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM