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Fruit Butter** <br />LI Ground <br />Chocolate <br />fiP.2 95/ <br />Pk 2 Coo 432_ COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />.v1/4gIVIRONMENTAL HEALTH UEPARTMENT <br />1M V68 East HazeIton Avenue, Stockton, CA 95205-6232 <br />elephone: (209) 468-3420 Fax: (209) 464-0138 Web: \vvvw siqov oru'EHD <br />CFO Busin9.5.s4\lame: Owner Name: <br />P-kp,e1 s /AA f I 4 vt <br />CFO Physical Address: CFO City: / <br />DR , IW4 <br />Website (If applicable): Telephone: <br />IA) LC/ <br /> <br />f4p4. <br />Categories: <br />[1] "Class A" (Direct Sales Only) $186 <br />Prohibited Items: <br />Da;_): /45/2.5, <br />CFO 4i ip: <br />f s4r,_? <br />/ 2,aq - ‘‘5-- ‘41f 0 <br />ar "Class B" (Direct & Indirect Sales) $486 <br />Initial if you agree to abide by the following: /14 <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 />"Clpss A" Self Certification Checklist: <br />a:/Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Dried Pasta Honey <br />LI <br />Baked Goods <br />LI Candy <br />Churros <br />Buttercream <br />Frosting/Icing* <br />Dried Mole Paste <br />Fruit Empanadas <br />Granola/Cereals <br />0 Cotton Candy <br />Dry Baking Mixes <br />El Waffle Cones <br />LI Buttercream <br />Fondant/Gumpaste* <br />Herb/Spice Blends <br />El Fruit Tamales/Pies <br />Seasoning Salt <br />El Candied Apples <br />Mustard <br />El Dried Grain Mixes <br />D Flat Icing <br />LI Pizzeles <br />ri Nut Mixes/Nut <br />Butters <br />LI Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />1-1 Popcorn/ <br />Popcorn Balls <br />EKVinegar <br />LI Jams/Jellies"* <br />Fried or Baked <br />LI Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM