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Ei Dried Pasta <br />El Dry Baking Mixes <br />El Waffle Cones <br />Buttercream LI Fondant/Gumpaste* <br />CI Herb/Spice Blends <br />El Fruit Tamales/Pies <br />LI Seasoning Salt <br />LI Candied Apples <br />LI <br />El <br />LI <br />LI <br />LI <br />LI <br />LI <br />LI <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 />1-7 Popcorn/ <br />Popcorn Balls <br />0 Vinegar <br />[1] Fruit Butter** <br />Ground LI Chocolate <br />El Jams/Jellies** <br />Fried or Baked <br />El Donuts and <br />Waffles <br />0 Dried Fruit <br />Marshmallows/ <br />0 Marshmallow <br />Bars* <br />CFO REG/PERMITTING FORM <br />.T'032_61 5 <br />El Baked Goods <br />El Dried Mole Paste <br />LI Fruit Empanadas <br />0 Granola/Cereals <br />Cotton Candy <br />2023 <br />LI Candy <br />LI Churros <br />LI Buttercream <br />Frosting/Icing* <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-623 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www sido <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 />flow-6r F\u)y- T(kWalf\ ODA-V. I- <br />CFO Zip: <br />Telephone: <br />-2-0°t-A.Qt.a3 (D <br />Categories: <br />IF "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: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br />Only foods that are defined as "non-potentially hazardgus" 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 />RECEIVED <br />"Class A" Self Certification Checklist: <br />V Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />FEB 1 4 2025 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />CFO Physical Address: <br />(2510 E- \-k(\e_ <br />Website (If applicable): <br />IN/ 1 A <br />CFO City: