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1. Categories: “Class B” (Direct & Indirect Sales) $486“Class A” (Direct Sales Only) $186 2. Prohibited Items: 4. Products: Please check the items you will be preparing and/or selling. Dried Pasta HoneyBaked Goods Vinegar Dry Baking Mixes MustardCandy Fruit Butter** Waffle Cones Dried Grain MixesChurros Flat Icing Jams/Jellies Herb/Spice Blends PizzelesDried Mole Paste Fruit Tamales/PiesFruit Empanadas Trail Mix/ Dried Fruit Dried Fruit Seasoning SaltGranola/Cereals Candied ApplesCotton Candy 1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 Buttercream Frosting/lcing* Buttercream Fondant/Gumpaste* Nut Mixes/Nut Butters Salted Caramel/Fudge Popcorn/ Popcorn Balls Ground Chocolate COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/EHD CFO Zip: ^yz4z- Owner Name: CFO City: CFO Business Name: CFO Physical Address: /4- (pl 3 KAdU Av-C Website (If applicable): Fried or Baked Donuts and Waffles Marshmallows/ Marshmallow Bars* 3. “Class A” Self Certification Checklist: Checklist completed (“Class A” CFOs Only) Telephone: i -4<g> H Initial if you agree to abide by the following: p i<Y ) Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness. Cafe: I > ___ _ /? %