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CFO Physical Address: CFO City: <br />MOvNTAIN htCuSE <br />Telephone <br /> <br />o? 951 -,E70/1 <br />CFO Zip: <br />cl6S9 1 7 gRerr A-vE <br />Website (If applicable): <br />Baked Goods 111 Dried Pasta <br />CI Candy <br />El Churros <br />111 Buttercream <br />Frosting/Icing* <br />El Dry Baking Mixes <br />C] Waffle Cones <br />CI Buttercream <br />Fondant/Gumpaste" <br />El Dried Mole Paste <br />111 Fruit Empanadas <br />1=1 Granola/Cereals <br />11 Cotton Candy <br />El Herb/Spice Blends <br />El Fruit Tamales/Pies <br />111 Seasoning Salt <br />LI Candied Apples <br />.17R1.. ti 2 I St <br />iNe <br />SAN JOAQUIN COUNTY fcL <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slqov.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: Date: <br />13AK.LAVA 1?) E S A m A-TH A CI UT TA LA <br />Categories: <br />I "Class A" (Direct Sales Only) $186 El "Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: Initial if you agree to abide by the following: S.G. <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 />INA Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El <br />El <br />El <br />111 <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 />Popcorn/ El Popcorn Balls <br />111 Vinegar <br />CI Fruit Butter"" <br />Ground CI Chocolate <br />CI Jams/Jellies** <br />Fried or Baked <br />111 Donuts and <br />Waffles <br />ID Dried Fruit <br />Marshmallows/ <br />C1 Marshmallow <br />Bars* <br />END 16-27 6/29/2023 1 CFO REG/PERMITTING FORM