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Date: <br />4.; LAwset-\ <br />CFO Zip: <br />LI Mustard <br />El Dried Grain Mixes <br />El Flat Icing <br />LI Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />LI <br />LI <br />LI <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 />REGISTRATIONIPERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATIO)) <br />CFO Buiess Nam a: Owner Name: <br /> <br />Gy or)q--tit‘ct s bqk_vi' i C:-/ CH Ili, ci <br />CFO Physiclal Address: CFO City: .-----i <br />(C: - -Bell . rcaiK. d i re-kctt <br />Website (If applicable): Telephone! <br />Categories: <br />"Class A" (Direct Sales Only) $186 LI "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following:C_14 r-- <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 />Ef-Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />LI Candy <br />LI Churros <br />Buttercream <br />Frosting/Icing* <br />El Dried Mole Paste <br />El Fruit Empanadas <br />LI Granola/Cereals <br />LI Cotton Candy <br />LI Dry Baking Mixes <br />11] Waffle Cones <br />Buttercream <br />Fondant/Gumpaste* <br />E] Herb/Spice Blends <br />LI Fruit Tamales/Pies <br />ID Seasoning Salt <br />LI Candied Apples <br />El Popcorn/ <br />Popcorn Balls <br />LI Vinegar <br />LI Fruit Butter** <br />LI <br />El Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />LI Dried Fruit <br />Marshmallows/ <br />LI Marshmallow <br />Bars* <br />2/ <br /> <br />Baked Goods LI Dried Pasta LI Honey <br />LI LI Ground <br />Chocolate <br />EHD 16-27 6/29/2023 <br /> 1 CFO REG/PERMITTING FORM <br />PR2500-1 S